Mahmoud Jallad, DDS, MSD

Primary specialty

DentistTaxonomy code 122300000X

License

019.029749 Issued in IL

Practice address

3024 S Park Ave
Herrin, IL 62948-3721

Phone

(833) 337-9563

NPI assigned

Aug 14, 2014

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

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CDEICA
• Direct secure messaging: mahmoud.jallad.p1@direct.chesi.nextgenshare.com

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.

• Herrin Dental LLC

  • Dental Clinic/Center
  • Herrin, IL
  • NPI 1275260218
  NPD Authorized official

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

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662336000000",
    "number": "1083013171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 ARABIAN CT",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483788",
            "telephone_number": "334-354-7852",
            "fax_number": "334-354-7852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3024 S PARK AVE",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483721",
            "telephone_number": "833-337-9563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JALLAD",
        "first_name": "MAHMOUD",
        "credential": "DDS, MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-14",
        "last_updated": "2022-09-05",
        "certification_date": "2022-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.029749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Ijames
• Independence Place, Inc.
• Suhail Istanbouly, MD
• Stephen H Jackson, MD
• Jeffrey Mark Jacobs, M.D.
• Rachael Nicole Janello, LPTA
• Javier Muniz, DO, LLC
• Angelina Johnson
• Kelly Jackson Johnson, PA-C
• Melody Johnson, LPN

• Dentist in Herrin, IL
• Providers in Herrin, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2022; 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.