Sodabeh Etminan, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.027979 Issued in IL

Practice address

7131 S Jeffery Blvd Ste a
Chicago, IL 60649-2176

Phone

(773) 256-0526

NPI assigned

Jul 28, 2009

Last updated

Sep 28, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• devoted network organization-27eb9117-6975-449a-a7ad-909243995ddc
• devoted network organization-734447cc-691b-4aa7-a112-9c9c8698dcc9
• IL HMO C-SNP

Interoperability endpoints

• Direct secure messaging: setminan16018@uihealth.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Board of Trustees of the University of Illinois

  • Anatomic Pathology Physician
  • Chicago, IL
  • NPI 1386863819
  Medicare reassignment NPD
• The Board of Trustees of the University of Illinois

  dba UIC-MSHC Hope Academy Health and Wellness CTR

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1043510241
  NPD
• The Board of Trustees of the University of Illinois

  dba Occupational Health Service Institute (OHSI)

  • Occupational Medicine Physician
  • Chicago, IL
  • NPI 1043727571
  NPD
• The Board of Trustees of the University of Illinois

  dba UI Health Mile Square Health Center L. P. Johnson Rockford

  • Federally Qualified Health Center (FQHC)
  • Rockford, IL
  • NPI 1306486022
  NPD
• The Board of Trustees of the University of Illinois

  dba Uih-Mile Square Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1669493466
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475020800000",
    "number": "1003047929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 S WOOD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081202",
            "telephone_number": "312-413-1789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7131 S JEFFERY BLVD STE A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606492176",
            "telephone_number": "773-256-0526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETMINAN",
        "first_name": "SODABEH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-28",
        "last_updated": "2016-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.027979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ethicadent
• Ethos Pharmacy
• Schmid Etienne
• Nicole Etling, MS, CCC/SLP
• Sophia Grace Etling, MA
• Darwin Eton, MD
• Rebecca Etrenne, APN
• Samantha Joy Etscheid, RN
• Rachel Elizabeth Etshokin
• Matthew Ettleson, MD

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.