NPIMap

Organization Active NPI

Modern Dental of Springfield PLLC

  • Dentist
  • Springfield, IL
National Provider Identifier
1013593953
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
MODERN DENTAL OF SPRINGFIELD PLLC
Practice address
3240 Hedley Rd Ste B
Springfield, IL 62711-6360
Phone
(217) 698-3400
Fax
(217) 698-3410
NPI assigned
Mar 22, 2021
Last updated
Mar 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Authorized official

Name
Dr. Michael Allen Morley, DMDNPI 1083793939
Title
Partner
Phone
(217) 698-3400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

3240 Hedley Rd Ste B
Springfield, IL 62711-6360

Mailing address

3240 Hedley Rd Ste B
Springfield, IL 62711-6360
Phone (217) 698-3400

Other identifiers 2

IdentifierTypeStateIssuer
1083793939OtherILDENTIST
1528441557OtherILDENTIST

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.ident.ws/template_include/new_patient_sign_in.do?site=7451&practiceId=27036 Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Locations

3240 Hedley Rd
Ste B
Springfield, IL 62711
Phone (217) 698-3400

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1616371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616371200000",
    "number": "1013593953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3240 HEDLEY RD STE B",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627116360",
            "telephone_number": "217-698-3400",
            "fax_number": "217-698-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3240 HEDLEY RD STE B",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627116360",
            "telephone_number": "217-698-3400",
            "fax_number": "217-698-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL OF SPRINGFIELD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-22",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A",
        "authorized_official_last_name": "MORLEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "217-698-3400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "1083793939",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "1528441557",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.ident.ws/template_include/new_patient_sign_in.do?site=7451&practiceId=27036",
            "affiliation": "N",
            "endpointDescription": "PHI forms",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "secure website",
            "address_1": "3240 Hedley Rd Ste B",
            "city": "Springfield",
            "state": "IL",
            "country_code": "US",
            "postal_code": "627116360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.