DR. ALIREZA SADRE-NASSIRI D.M.D.
NPI 1740544303
Dentist - Pediatric Dentistry in Lakeport, CA

Q: What is Alireza Sadre-nassiri's NPI number?

The NPI number for Alireza Sadre-nassiri is 1740544303. It was assigned to this individual provider in the NPPES registry on June 28, 2012.

Q: What is Alireza Sadre-nassiri's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Active since June 28, 2012PECOS Enrolled

925 BEVINS CT, LAKEPORT, CA 95453(707) 263-8382(707) 263-5326 Get Directions Write a Review

NPPES record last updated: August 1, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 13, 2022, Jul 29, 2019, Aug 9, 2017 (3 updates tracked since 2017).

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About Dr. Alireza Sadre-nassiri D.m.d. NPPES

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

DR. ALIREZA SADRE-NASSIRI D.M.D. (NPI 1740544303) is an individual pediatric dentistry provider in Lakeport, California, licensed in California (109541) and active in the NPI registry since June 2012. He is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1740544303

Entity TypeIndividualMale

Primary Taxonomy1223P0221X

Provider Legal NameDR. ALIREZA SADRE-NASSIRICredential: D.M.D.

Location Address925 BEVINS CTLakeport, CA 95453-9754

Mailing AddressPo Box 1950Lakeport, CA 95453-1950 · (707) 263-8382

Phone(707) 263-8382

Fax(707) 263-5326

Sole ProprietorNo

Enumeration DateJune 28, 2012

Last NPPES UpdateAugust 1, 20253 updates tracked since enumeration

NPPES CertifiedAugust 1, 2025

✔ NPI 1740544303 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

Licenses✔ Licensed in CA · 109541✔ Licensed in NY · 056780

Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

Also ListedDentistTaxonomy 122300000X · License 056780 (NY), 60737991 (WA)

925 BEVINS CT, Lakeport, CA 95453

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Secondary Practice Locations 2

Location 16003 100th St SWLakewood, WA 98499-2733 · Phone (425) 466-0595

Location 214440 Olympic DrClearlake, CA 95422-8809 · Phone (707) 263-8382 · Fax (707) 461-5102

Other Identifiers 1

Medicaid1223G0001XCT

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Alireza Sadre-nassiri D.m.d. 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.

Medicare Billing Reassignments

Medicare enrollment records show Alireza Sadre-nassiri reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Lake County Tribal Health Consortium Inc.

Same address

Federally Qualified Health Center (FQHC)

925 BEVINS CT
Lakeport, CA 95453

Reassigned Medicare billing, California enrollment
59 clinicians in this Medicare group

NPI 1881697381 (707) 263-8382

Santa Rosa Community Health Centers

40 mi

Federally Qualified Health Center (FQHC)

3569 ROUND BARN CIRCLE
Santa Rosa, CA 95403

Reassigned Medicare billing, California enrollment
215 clinicians in this Medicare group

NPI 1578631172 (707) 303-3600

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95453 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

$90.32 typical visit price

range $58.87 – $176.60

Typical copayment $22.58 (range $14.71 – $44.15)

Most-billed visit code 99203

Established Patient

$73.16 typical visit price

range $19.28 – $144.60

Typical copayment $18.29 (range $4.82 – $36.15)

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.

MERRILL FEATHERSTONE MFC

Counselor (Mental Health)