Individual provider Active NPI

Christie Marie Samrai, DMD

  • General Practice Dentistry
  • Glenview, IL
National Provider Identifier
1154724664
Registry record updated Oct 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019.029961 Issued in IL
Practice address
1730 Dewes St
Glenview, IL 60025-4316
Phone
(847) 724-2160
NPI assigned
Sep 29, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2014

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 019.029961 IL Primary

Addresses

Primary practice location

1730 Dewes St
Glenview, IL 60025-4316

Mailing address

1730 Dewes St
Glenview, IL 60025-4316
Phone (847) 724-2160

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
I20151023002411 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8921317447

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.029961ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Bordignon Dental Associates Past Accepting new patients
Bordignon Dental Associates PastSince Dec 22, 2019 Accepting new patients

Organizations & group practices 2

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": "1411948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413590400000",
    "number": "1154724664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1730 DEWES ST",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600254316",
            "telephone_number": "847-724-2160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 DEWES ST",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600254316",
            "telephone_number": "847-724-2160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMRAI",
        "first_name": "CHRISTIE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-29",
        "last_updated": "2014-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.029961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenview, IL

Sources for this page

Verify at the official NPI Registry.