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SARA SUPRIYATNO DDS
NPI 1225775778
Student in an Organized Health Care Education/Training Program in Philadelphia, PA

Active since May 17, 2022PECOS Enrolled
909 WALNUT ST RM 300, PHILADELPHIA, PA 19107(215) 503-7118(215) 923-9189 Get Directions Write a Review

NPPES record last updated: January 9, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Sara Supriyatno Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SARA SUPRIYATNO DDS (NPI 1225775778) is an individual student in an organized health care education/training program in Philadelphia, Pennsylvania and active in the NPI registry since May 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1225775778
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameSARA SUPRIYATNOCredential: DDS
Location Address909 WALNUT ST RM 300Philadelphia, PA 19107-5211
Mailing Address909 Walnut St Rm 300Philadelphia, PA 19107-5211 · (215) 503-7118 · Fax (215) 923-9189
Phone(215) 503-7118
Fax(215) 923-9189
Sole ProprietorNo
Enumeration DateMay 17, 2022
Last NPPES UpdateJanuary 9, 2024
NPPES CertifiedJanuary 9, 2024
✔ NPI 1225775778 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedDentist · General PracticeTaxonomy 1223G0001X · License DS043687 (PA)
909 WALNUT ST RM 300, Philadelphia, PA 19107
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sara Supriyatno Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. AUSTIN ROBERT HALE DDS
Oral & Maxillofacial Surgery
909 WALNUT ST RM 300
PHILADELPHIA, PA 19107
Philadelphia County (215) 503-6215
YU JIN LEE DMD
Student in an Organized Health Care Education/Training Program
909 WALNUT ST RM 300
PHILADELPHIA, PA 19107
Philadelphia County (215) 503-6215
DAKOTA LAWTON MCKENZIE DDS
Dentist (Oral and Maxillofacial Surgery)
909 WALNUT ST RM 300
PHILADELPHIA, PA 19107
Philadelphia County (215) 503-6215
DR. GABRIELLA MERCEDES LO MONACO
Student in an Organized Health Care Education/Training Program
909 WALNUT ST RM 300
PHILADELPHIA, PA 19107
Philadelphia County (215) 503-7118
JOHN HENRY MASI DMD
Dentist (Oral and Maxillofacial Surgery)
909 WALNUT ST RM 300
PHILADELPHIA, PA 19107
Philadelphia County (215) 503-7118
DR. CHRISTOPHER LOUIS HACKETT DDS
Student in an Organized Health Care Education/Training Program
909 WALNUT ST RM 300
PHILADELPHIA, PA 19107
Philadelphia County (215) 503-6215
DR. AMELIA BRYNNE WILSON DMD
Student in an Organized Health Care Education/Training Program
909 WALNUT ST RM 300
PHILADELPHIA, PA 19107
Philadelphia County (215) 503-6215
DR. DYLAN P SALEM DDS
Dentist
909 WALNUT ST RM 300
PHILADELPHIA, PA 19107
Philadelphia County (215) 955-6215

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sara Supriyatno's NPI number?

The NPI number for Sara Supriyatno is 1225775778. It was assigned to this individual provider in the NPPES registry on May 17, 2022.

Where is Sara Supriyatno located?

Sara Supriyatno practices at 909 Walnut St Rm 300, Philadelphia, PA 19107. The listed phone number is (215) 503-7118.

What is Sara Supriyatno's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Sara Supriyatno enrolled in Medicare?

Yes. Sara Supriyatno is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Sara Supriyatno was last updated on January 9, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.