Mark Raymond Hudson, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

1006 S Market St
Monticello, IL 61856-1842

Phone

(121) 776-2945

Fax

(121) 776-2945

NPI assigned

Feb 2, 2007

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053459735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 S MARKET ST",
            "city": "MONTICELLO",
            "state": "IL",
            "postal_code": "618561842",
            "telephone_number": "121-776-2945",
            "fax_number": "121-776-2945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 S MARKET ST",
            "city": "MONTICELLO",
            "state": "IL",
            "postal_code": "618561842",
            "telephone_number": "121-776-2945",
            "fax_number": "121-776-2945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "MARK",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "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": []
}

• Michael Alan Harris, R.PH., MS, MBA
• Katelynn Nichole Hayes, APN
• Brittany Hicks, FNP
• Brandon J Hissong, DMD
• Evelyn Huang, MD
• Illini Eyecare Monticello Inc
• David M Jahn, PAC
• John & Mary E Kirby Hospital
• Curtis E Johnson, OD
• Madelynn Ann Kallembach, ATC

• General Practice Dentistry in Monticello, IL
• Providers in Monticello, 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 Jul 8, 2007; 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.