Active NPI
Andrew Adiputra
- Dentist
- Champaign, IL
National Provider Identifier
1205489671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019032270
- Practice address
- 314 W Kirby Ave
Champaign, IL 61820-7208 - Phone
- (217) 398-9898
- NPI assigned
- Jul 24, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019032270 | IL | Primary |
Addresses
Primary practice location
314 W Kirby Ave
Champaign, IL 61820-7208
Mailing address
314 W Kirby Ave
Champaign, IL 61820-7208
Phone (217) 398-9898
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019032270 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Professionals of Illinois, P.C. | 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.
-
- General Practice Dentistry
- Champaign, IL
- NPI 1316149867
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563926400000",
"number": "1205489671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "314 W KIRBY AVE",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618207208",
"telephone_number": "217-398-9898"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "314 W KIRBY AVE",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618207208",
"telephone_number": "217-398-9898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ADIPUTRA",
"first_name": "ANDREW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-24",
"last_updated": "2019-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019032270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
- Michele Adams
- Addus Healthcare Inc
- Addus Healthcare, Inc.
- Patience Okpaku Adesida, MD
- Ghada Adhami, DDS
- Advanced Aesthetics Surgery & Laser Center, P.C.
- Advanced Chiropractic and Rehabilitation Center, P.C.
- Advanced Medical Transport East Inc.
- Audrey K Aeilts
- Affiliates in Oral & Maxillofacial Surgery LTD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.