Lary Michael Pane, DDS

Primary specialty

DentistTaxonomy code 122300000X

Practice address

4420 St Charles Road
Bellwood, IL 60104

Phone

(708) 547-7160

Fax

(630) 426-0211

NPI assigned

Dec 15, 2006

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Practice roles

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.

• Lary M. Pane, D.D.S.,P.C.

  • Dentist
  • Bellwood, IL
  • NPI 1003080136
  NPD (past) Authorized official

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1235291287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4420 ST CHARLES ROAD",
            "city": "BELLWOOD",
            "state": "IL",
            "postal_code": "60104",
            "telephone_number": "708-547-7160",
            "fax_number": "630-426-0211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 ST CHARLES ROAD",
            "city": "BELLWOOD",
            "state": "IL",
            "postal_code": "60104",
            "telephone_number": "708-547-7160",
            "fax_number": "630-426-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANE",
        "first_name": "LARY",
        "middle_name": "MICHAEL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005522",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nora Myers, CRSS
• Nkeiruka Nnam, PHARM D.
• Occu - Sports Med Corp (Advanced Occupational Medicine Specialists)
• Occupational Health Centers of Illinois PC (Concentra Medical Centers)
• Modupe Oladeinde, MD
• Sandra Pinilla, M.D.
• Premo Medical Supply Inc
• Proviso Public Partnership
• Brenda Ramirez
• Resilient House

• Dentist in Bellwood, IL
• Providers in Bellwood, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.