Active NPI
Carl Thomas Drake, D.D.S., M.S.
- Dentist
- Normal, IL
National Provider Identifier
1124227228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.027428
- Practice address
- 310 Susan Dr
Ste 1
Normal, IL 61761-6206 - Phone
- (309) 808-0054
- NPI assigned
- Jul 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.027428 | IL | Primary |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 021.002368 | IL |
Addresses
Primary practice location
310 Susan Dr
Ste 1
Normal, IL 61761-6206
Mailing address
310 Susan Drive, Suite 1
Normal, IL 61761
Phone (309) 808-0054
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 17, 2016 through May 17, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.027428 | IL | MD | Dentist |
| 021.002368 | IL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306454400000",
"number": "1124227228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "310 SUSAN DRIVE, SUITE 1",
"city": "NORMAL",
"state": "IL",
"postal_code": "61761",
"telephone_number": "309-808-0054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 SUSAN DR",
"address_2": "STE 1",
"city": "NORMAL",
"state": "IL",
"postal_code": "617616206",
"telephone_number": "309-808-0054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAKE",
"first_name": "CARL",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "D.D.S., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-17",
"last_updated": "2011-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.027428",
"primary": true
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "IL",
"license": "021.002368",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2011; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.