Individual provider Active NPI

Randall Frank Summers, D.D.S.

  • General Practice Dentistry
  • Bolingbrook, IL
National Provider Identifier
1164577128
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
391 Quadrangle Dr
Suite S-5
Bolingbrook, IL 60440-3442
Phone
(630) 759-4400
Fax
(630) 759-9528
NPI assigned
Jan 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 IL Primary

Addresses

Primary practice location

391 Quadrangle Dr
Suite S-5
Bolingbrook, IL 60440-3442

Mailing address

1137 Marshall CT
Naperville, IL 60565-3477
Phone (630) 759-4400

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
I20160413002477 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6103124839

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019014414ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Randall F. Summers, D.D.S.,LTD 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.

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164577128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 MARSHALL CT",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605653477",
            "telephone_number": "630-759-4400",
            "fax_number": "630-759-9528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "391 QUADRANGLE DR",
            "address_2": "SUITE S-5",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604403442",
            "telephone_number": "630-759-4400",
            "fax_number": "630-759-9528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERS",
        "first_name": "RANDALL",
        "middle_name": "FRANK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

Verify at the official NPI Registry.