Bart J. Paul, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.017887 Issued in IL

Practice address

1957 Pawlisch Dr
Rockford, IL 61112-1067

Phone

(815) 332-3477

NPI assigned

Jan 30, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cherryvale Dental Center LLC

  • Dental Clinic/Center
  • Rockford, IL
  • NPI 1669094041
  NPD Authorized official

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1205972585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1957 PAWLISCH DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121067",
            "telephone_number": "815-332-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1957 PAWLISCH DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121067",
            "telephone_number": "815-332-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAUL",
        "first_name": "BART",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.017887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "783656",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003279",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Viral Manubhai Patel, O.D.
• Path of Humanity, Inc. (Visiting Angels Rockford IL)
• Patients Choice Medical Center LTD
• Patrick B. Whitaker, D.C., P.C.
• Paul Revis MD SC
• Jaison Paul, MD
• Jon A Paul, D.C.
• Paula Tripodi LCSW
• Stacy Renee Pauley, RN, BSN, CHPN
• Yevhen Pavelko, MD

• General Practice Dentistry in Rockford, IL
• Providers in Rockford, 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 Jul 9, 2007; 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.