Individual provider Active NPI

James Patrick Ryan, DDS

  • Dentist
  • Bartlett, IL
National Provider Identifier
1104087956
Registry record updated Jun 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019-022852 Issued in IL
Practice address
840 W Bartlett Rd
Bartlett, IL 60103-4450
Phone
(630) 837-5947
Fax
(630) 837-6501
NPI assigned
Jun 24, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019-022852 IL Primary

Addresses

Primary practice location

840 W Bartlett Rd
Bartlett, IL 60103-4450

Mailing address

840 W Bartlett Rd
Bartlett, IL 60103-4450
Phone (630) 837-5947

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
I20160506000296 IL Order and Referring Only - DentistPractitioner - Dentist 3173822533

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-022852ILMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214265600000",
    "number": "1104087956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 W BARTLETT RD",
            "city": "BARTLETT",
            "state": "IL",
            "postal_code": "601034450",
            "telephone_number": "630-837-5947",
            "fax_number": "630-837-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 W BARTLETT RD",
            "city": "BARTLETT",
            "state": "IL",
            "postal_code": "601034450",
            "telephone_number": "630-837-5947",
            "fax_number": "630-837-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "JAMES",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-24",
        "last_updated": "2008-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019-022852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bartlett, IL

Sources for this page

Verify at the official NPI Registry.