ALEX PROVO
NPI 1750762555
Dentist in Ada, MN
NPI Status: Active since June 17, 2015
- Individual
- Male
- Dentist
- PECOS Enrolled
- Opted-Out Medicare
About ALEX PROVO
This page provides the complete NPI Profile along with additional information for Alex Provo, a provider established in Ada, Minnesota with a medical specialization in Dentist. The healthcare provider is registered in the NPI registry with number 1750762555 assigned on June 2015. The practitioner's primary taxonomy code is 122300000X with license number D13521 (MN). The provider is registered as an individual and his NPI record was last updated 10 years ago.
- NPI
- 1750762555
- Provider Name
- ALEX PROVO
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 200 E MAIN ST ADA, MN 56510
- Location Phone
- (218) 784-7119
- Mailing Address
- 18185 PARK DR DETROIT LAKES, MN 56501
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 06-17-2015
- Last Update Date
- 06-17-2015
- Code Navigator
A dentist like Alex Provo is a skilled in and licensed provider that diagnoses and treats problems with patients teeth, gums, and related parts of the mouth. Dentists educate patients on how to take care of the teeth and gums and provide information on diet choices that affect oral health. Dentists must be licensed in the state in which they work.
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Alex Provo opted out of Medicare effective on 01-05-2016 until 01-05-2026. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare but is permitted to order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dentist
- Taxonomy Code
- 122300000X
- Type
- Dental Providers
- License No.
- D13521
- License State
- MN
- Taxonomy Description
- A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
Medicare Participation & PECOS Enrollment Status
Alex Provo is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME) and a Home Health Agency (HHA).
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 01-05-2016
Opt-Out End Date: 01-05-2026
Eligible to Order and Refer? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: No
Physician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 56510 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $85.82
- Minimum New Patient Price $56
- Maximum New Patient Price $168.28
- Average New Patient Copayment $21.45
- Minimum New Patient Copayment $14
- Maximum New Patient Copayment $42.07
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $69.74
- Minimum Established Patient Price $18.32
- Maximum Established Patient Price $138.04
- Average Established Patient Copayment $17.43
- Minimum Established Patient Copayment $4.58
- Maximum Established Patient Copayment $34.51
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 7 | 5 | 0 | 7 | 6 | 2 | 5 | 5 | 5 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 7 | 10 | 0 | 14 | 6 | 4 | 5 | 10 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 7 + 1 + 0 + 0 + 1 + 4 + 6 + 4 + 5 + 1 + 0 + 24 = 55 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 55 = 5 | 5 | ||||||||
The NPI number 1750762555 is valid because the calculated check digit 5 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 3 providers are registered at the same or nearby location.
DR. DAVID A RESNICK D.D.S.
Dentist
(General Practice)
200 E MAIN ST
ADA, MN
ZIP 56510
DR. DEBRA A ETTLE D.D.S.
Dentist
(General Practice)
200 E MAIN ST
ADA, MN
ZIP 56510
PRAIRIE DENTAL CENTERS PA
Dentist
(General Practice)
200 E MAIN ST
ADA, MN
ZIP 56510
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1750762555, enumerated as an "individual" on June 17, 2015.
The provider is located at 200 E MAIN ST ADA, MN 56510 and the phone number is (218) 784-7119.
Dentist with taxonomy code 122300000X.
