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DR. BRETT MICHAEL DISALLE DDS
NPI 1609962646
Dentist - General Practice in Fort Wayne, IN

Active since October 05, 2006PECOS Enrolled
2121 LAKE AVE, FORT WAYNE, IN 46805(260) 460-1353(260) 460-1308 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Brett Michael Disalle Dds NPPES

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

DR. BRETT MICHAEL DISALLE DDS (NPI 1609962646) is an individual general practice provider in Fort Wayne, Indiana, licensed in Indiana (12009812) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1609962646
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. BRETT MICHAEL DISALLECredential: DDS
Location Address2121 LAKE AVEFort Wayne, IN 46805-5100
Mailing Address430 Augusta WayFort Wayne, IN 46825-2175 · (260) 497-9615
Phone(260) 460-1353
Fax(260) 460-1308
Sole ProprietorNo
Enumeration DateOctober 5, 2006
Last NPPES UpdateJuly 8, 2007
✔ NPI 1609962646 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in IN · 12009812
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
2121 LAKE AVE, Fort Wayne, IN 46805
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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)

Dr. Brett Michael Disalle 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46805 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$82.04 typical visit price
range $53.07 – $161.76
Typical copayment $20.51 (range $13.26 – $40.44)
Most-billed visit code 99203
Established Patient
$66.48 typical visit price
range $16.93 – $132.22
Typical copayment $16.62 (range $4.23 – $33.05)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

TAMMY MOEHLE
Registered Nurse (Oncology)
2121 LAKE AVE
FORT WAYNE, IN 46805
Allen County (260) 426-5431
DR. CALEB ANDREW MOSSBURG PHARMD
Pharmacist
2121 LAKE AVE
FORT WAYNE, IN 46805
Allen County (260) 426-5431
DR. ASHLEY M FULTON PHARMD
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
2121 LAKE AVE
FORT WAYNE, IN 46805
Allen County (260) 426-5431
HANNAH DULINSKY RN
Registered Nurse (Home Health)
2121 LAKE AVE
FORT WAYNE, IN 46805
Allen County (260) 460-1445
DANIELLE SCHULTZ
Registered Nurse
2121 LAKE AVE
FORT WAYNE, IN 46805
Allen County (260) 426-5431
DR. IAN H. COOK M.D.
Surgery
2121 LAKE AVE, VETERANS AFFAIRS MEDICAL CENTER
FORT WAYNE, IN 46805
Allen County (260) 426-5431
SCOTT KRUSE
Social Worker (Clinical)
2121 LAKE AVE
FORT WAYNE, IN 46805
Allen County (260) 426-5431
MONICA JANE HALL
Registered Nurse (General Practice)
2121 LAKE AVE
FORT WAYNE, IN 46805
Allen County (260) 456-0543

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 Brett Disalle's NPI number?

The NPI number for Brett Disalle is 1609962646. It was assigned to this individual provider in the NPPES registry on October 5, 2006.

Where is Brett Disalle located?

Brett Disalle practices at 2121 Lake Ave, Fort Wayne, IN 46805. The listed phone number is (260) 460-1353.

What is Brett Disalle's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Brett Disalle enrolled in Medicare?

Yes. Brett Disalle is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Brett Disalle was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.