Individual provider Active NPI

Phillip Charles Neal, D.D.S.

  • General Practice Dentistry
  • Crystal Lake, IL
National Provider Identifier
1053482471
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
280 Memorial CT Ste B
Crystal Lake, IL 60014-6233
Phone
(815) 459-2202
Fax
(815) 459-2787
NPI assigned
Nov 10, 2006
Sex
Male
Sole proprietor
No

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

280 Memorial CT Ste B
Crystal Lake, IL 60014-6233

Mailing address

280 Memorial CT Ste B
Crystal Lake, IL 60014-6233
Phone (815) 459-2202

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20150529000799 IL Order and Referring Only - DentistPractitioner - Dentist 1456492339

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.015895ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Neal and Associates PC Past Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053482471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 MEMORIAL CT STE B",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146233",
            "telephone_number": "815-459-2202",
            "fax_number": "815-459-2787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 MEMORIAL CT STE B",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146233",
            "telephone_number": "815-459-2202",
            "fax_number": "815-459-2787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEAL",
        "first_name": "PHILLIP",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-10",
        "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 Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.