Ellen E Tkach, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

1846 Belvidere Rd
Grayslake, IL 60030-2289

Phone

(847) 223-0100

Fax

(847) 223-6528

NPI assigned

Apr 9, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207785600000",
    "number": "1194998252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1846 BELVIDERE RD",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600302289",
            "telephone_number": "847-223-0100",
            "fax_number": "847-223-6528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1846 BELVIDERE RD",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600302289",
            "telephone_number": "847-223-0100",
            "fax_number": "847-223-6528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TKACH",
        "first_name": "ELLEN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-09",
        "last_updated": "2008-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003995",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Grayslake, IL
• Providers in Grayslake, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.