Active NPI
James Poulos, DDS
- Dentist
- Chicago, IL
National Provider Identifier
1235333154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019020091
- Practice address
- 5470 W Madison St
Chicago, IL 60644-4031 - Phone
- (773) 287-2277
- Fax
- (773) 287-2573
- NPI assigned
- Jun 13, 2007
- 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 | 019020091 | IL | Primary |
Addresses
Primary practice location
5470 W Madison St
Chicago, IL 60644-4031
Mailing address
5470 W Madison St
Chicago, IL 60644-4031
Phone (773) 287-2277
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160919001259 | IL | Order and Referring Only - Other (Non-Physician) | 9436446416 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019020091 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235333154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5470 W MADISON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606444031",
"telephone_number": "773-287-2277",
"fax_number": "773-287-2573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5470 W MADISON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606444031",
"telephone_number": "773-287-2277",
"fax_number": "773-287-2573"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POULOS",
"first_name": "JAMES",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019020091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.