Larry D Otte, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

021-001850 Issued in IL

Practice address

2807 N Knoxville Ave
Peoria, IL 61604-2869

Phone

(309) 682-1213

NPI assigned

Mar 16, 2007

Last updated

Oct 2, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 19, 2017 through Dec 19, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222905600000",
    "number": "1194859355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2807 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616042869",
            "telephone_number": "309-682-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2807 N KNOXVILLE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616042869",
            "telephone_number": "309-682-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTE",
        "first_name": "LARRY",
        "middle_name": "D",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2008-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-024407",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021-001850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PT10",
            "identifier": "909830",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Osterloo, LCPC
• Mallory Osterloo, LCPC
• Sydney Brianne Ostrowsky
• Chukwunenye Kamalu Osuji, M.D.
• Barbara E. Ott, O.D.
• Louise A. Otte, S.T.
• Erin Jean Overcash, W.H.N.P.
• Larry F Overcash, M.D.
• Patti Overcash, FNP
• Erica Lourdes Owchar, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Peoria, IL
• Providers in Peoria, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2008; 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.

Verify at the official NPI Registry.