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TADELE DEMISSE DMD
NPI 1942866280
Dentist - General Practice in Philadelphia, PA

Active since May 13, 2019PECOS Enrolled
6120B WOODLAND AVE, PHILADELPHIA, PA 19142(267) 597-3600 Get Directions Write a Review

NPPES record last updated: December 28, 2023. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 21, 2021, May 17, 2021, May 13, 2019 (3 updates tracked since 2019).

About Tadele Demisse Dmd NPPES

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

TADELE DEMISSE DMD (NPI 1942866280) is an individual general practice provider in Philadelphia, Pennsylvania, licensed in Pennsylvania (DS043969) and active in the NPI registry since May 2019. He is enrolled in Medicare PECOS and maintains 3 additional practice locations.

NPPES Registry Identity

NPI1942866280
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameTADELE DEMISSECredential: DMD
Location Address6120B WOODLAND AVEPhiladelphia, PA 19142-3224
Mailing Address4700 Wissahickon AvePhiladelphia, PA 19144-4248 · (267) 597-3600
Phone(267) 597-3600
Sole ProprietorNo
Enumeration DateMay 13, 2019
Last NPPES UpdateDecember 28, 20233 updates tracked since enumeration
NPPES CertifiedDecember 28, 2023
✔ NPI 1942866280 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Licenses✔ Licensed in PA · DS043969✔ Licensed in NY · 061697
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.
6120B WOODLAND AVE, Philadelphia, PA 19142
Open in Google Maps ↗

Secondary Practice Locations 3

Location 11044 State StSchenectady, NY 12307-1508 · Phone (518) 370-1441 · Fax (518) 395-9431
Location 24700 Wissahickon Ave Ste 118Philadelphia, PA 19144-4248 · Phone (267) 597-3600 ext. 5206
Location 3850 N 11th StPhiladelphia, PA 19123-1957 · Phone (267) 597-3600 ext. 5206

Other Identifiers 4

Medicaid02995513NY
Other53099ANY · Pin
Other331833NY · Oscar
Medicaid10000017080506PA

Accepted Insurance

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

Tadele Demisse Dmd 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

2

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

Philadelphia Fight
3.8 mi
Federally Qualified Health Center (FQHC)
1233 LOCUST ST FL 4
Philadelphia, PA 19107
  • Reassigned Medicare billing, Pennsylvania enrollment
  • 44 clinicians in this Medicare group
NPI 1487082608 (215) 790-1788
Schenectady Family Health Services, Inc.
209 mi
Dental
1108 STATE ST
Schenectady, NY 12304
  • Reassigned Medicare billing, New York enrollment
  • 57 clinicians in this Medicare group
NPI 1457024218 (518) 370-1441

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 19142 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
$92.69 typical visit price
range $59.88 – $180.99
Typical copayment $23.17 (range $14.97 – $45.24)
Most-billed visit code 99203
Established Patient
$74.47 typical visit price
range $19.30 – $147.29
Typical copayment $18.61 (range $4.82 – $36.82)
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.

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 Tadele Demisse's NPI number?

The NPI number for Tadele Demisse is 1942866280. It was assigned to this individual provider in the NPPES registry on May 13, 2019.

Where is Tadele Demisse located?

Tadele Demisse practices at 6120B Woodland Ave, Philadelphia, PA 19142. The listed phone number is (267) 597-3600.

What is Tadele Demisse's specialty?

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

Is Tadele Demisse enrolled in Medicare?

Yes. Tadele Demisse is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Tadele Demisse's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tadele Demisse reassigns Medicare benefits to 2 organizations: Philadelphia Fight (Philadelphia, PA) and Schenectady Family Health Services, Inc. (Schenectady, NY). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tadele Demisse's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Tadele Demisse accept?

Health plans from BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and HRI Dental & Vision and 4 other insurers list Tadele Demisse as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Tadele Demisse was last updated on December 28, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.