NPIMap

Organization Active NPI

Myorthos Illinois Orthodontics PC

Doing business as Premier Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Ottawa, IL
National Provider Identifier
1194454454
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
Legal business name
MYORTHOS ILLINOIS ORTHODONTICS PC
Doing business as
Premier Orthodontics
Practice address
1704 Polaris Cir
Ottawa, IL 61350-1773
Phone
(815) 434-4222
NPI assigned
Jun 9, 2022
Organization subpart
Yes
Parent organization
MYORTHOS ILLINOIS ORTHODONTICS PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Authorized official

Name
Casey Lonabocker
Title
VP Operations & Strategy
Phone
(617) 535-3364

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X Primary

Addresses

Primary practice location

1704 Polaris Cir
Ottawa, IL 61350-1773

Mailing address

131 Dartmouth St FL 3
Boston, MA 02116-5297
Phone (617) 535-3305

Other practice location 1

2050 Marquette Rd Ste 200
Peru, IL 61354-4000
Phone (815) 224-2355

Other names 1

  • Premier Orthodontics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Myorthos Illinois Orthodontics PC5 organizations share this tax ID, including this one
Part of
Myorthos Illinois Orthodontics PC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2050 Marquette Rd
Ste 200
Peru, IL 61354
Phone (815) 224-2355

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1194454454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 DARTMOUTH ST FL 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021165297",
            "telephone_number": "617-535-3305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 POLARIS CIR",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613501773",
            "telephone_number": "815-434-4222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2050 Marquette Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Peru",
            "state": "IL",
            "postal_code": "613544000",
            "country_code": "US",
            "telephone_number": "815-224-2355",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MYORTHOS ILLINOIS ORTHODONTICS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MYORTHOS ILLINOIS ORTHODONTICS PC",
        "enumeration_date": "2022-06-09",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "LONABOCKER",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "VP OPERATIONS & STRATEGY",
        "authorized_official_telephone_number": "617-535-3364"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Premier Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ottawa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.