Active NPI
Ann Tice, M.D.
- Dermatology Physician
- Champaign, IL
National Provider Identifier
1235240904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Practice address
- 1 E Main St
Suite 103
Champaign, IL 61820-3654 - Phone
- (217) 693-4400
- NPI assigned
- Aug 31, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | IL | Primary |
Addresses
Primary practice location
1 E Main St
Suite 103
Champaign, IL 61820-3654
Mailing address
4007 Golf Creek Dr
Champaign, IL 61822-9208
Phone (217) 351-1844
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036064484 | IL | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203897600000",
"number": "1235240904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4007 GOLF CREEK DR",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618229208",
"telephone_number": "217-351-1844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 E MAIN ST",
"address_2": "SUITE 103",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618203654",
"telephone_number": "217-693-4400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TICE",
"first_name": "ANN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-31",
"last_updated": "2008-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.