Active NPI
Garrett David Gast, DDS
- Dentist
- Chicago, IL
National Provider Identifier
1154595379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9844
- Practice address
- 3435 W Irving Park Rd
Chicago, IL 60618-3217 - Phone
- (773) 588-8200
- Fax
- (773) 588-8208
- NPI assigned
- Apr 18, 2008
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 56258 | CA | |
| Dentist | 122300000X | 019028623 | IL | |
| Dentist | 122300000X | 9844 | KY | Primary |
Addresses
Primary practice location
3435 W Irving Park Rd
Chicago, IL 60618-3217
Mailing address
8700 Dixie Highway
Louisville, KY 40258
Phone (502) 935-0505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161031000290 | OH | Order and Referring Only - Dentist | 6901184712 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56258 | CA | MD | Dentist |
| 019028623 | IL | MD | Dentist |
| 9844 | KY | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Irving Park Family Dentist | Dentist | 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.
-
- General Practice Dentistry
- Chicago, IL
- NPI 1942595442
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472774400000",
"number": "1154595379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8700 DIXIE HIGHWAY",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "40258",
"telephone_number": "502-935-0505",
"fax_number": "502-935-2602"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3435 W IRVING PARK RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606183217",
"telephone_number": "773-588-8200",
"fax_number": "773-588-8208"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAST",
"first_name": "GARRETT",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-04-18",
"last_updated": "2016-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "56258",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019028623",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "9844",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.