Individual provider Active NPI

Christa D Hopp, DMD

  • General Practice Dentistry
  • Glen Carbon, IL
National Provider Identifier
1023124666
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
21 Glen Ed Professional Park
Glen Carbon, IL 62034-3333
Phone
(618) 656-8436
Fax
(618) 656-3534
NPI assigned
Aug 23, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X IL Primary

Addresses

Primary practice location

21 Glen Ed Professional Park
Glen Carbon, IL 62034-3333

Mailing address

21 Glen Ed Professional Park
Glen Carbon, IL 62034-3333
Phone (618) 656-8436

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20160603000910 MO Order and Referring Only - DentistPractitioner - Dentist 0042500068

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-026177ILMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1023124666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 GLEN ED PROFESSIONAL PARK",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343333",
            "telephone_number": "618-656-8436",
            "fax_number": "618-656-3534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GLEN ED PROFESSIONAL PARK",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343333",
            "telephone_number": "618-656-8436",
            "fax_number": "618-656-3534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOPP",
        "first_name": "CHRISTA",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Carbon, IL

Sources for this page

Verify at the official NPI Registry.