Active NPI
Kristin Marie Andrews, D.D.S.
- Dentist
- Blue Island, IL
National Provider Identifier
1235450362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.028314
- Practice address
- 12200 Western Ave
Blue Island, IL 60406-1398 - Phone
- (708) 385-3700
- NPI assigned
- Jun 11, 2010
- Last updated
- Jun 29, 2016
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019.028314 | IL | Primary |
Addresses
Primary practice location
12200 Western Ave
Blue Island, IL 60406-1398
Mailing address
2525 S Cleveland Ave
Ste 200
Saint Joseph, MI 49085-2649
Phone (920) 838-1649
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160701001538 | MI | Order and Referring Only - Oral Surgery | 0547552085 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.028314 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276214400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467158400000",
"number": "1235450362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2525 S CLEVELAND AVE",
"address_2": "STE 200",
"city": "SAINT JOSEPH",
"state": "MI",
"postal_code": "490852649",
"telephone_number": "920-838-1649"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12200 WESTERN AVE",
"city": "BLUE ISLAND",
"state": "IL",
"postal_code": "604061398",
"telephone_number": "708-385-3700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDREWS",
"first_name": "KRISTIN",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-11",
"last_updated": "2016-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.028314",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blue Island, IL
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- Mark William Anderson, D.D.S.
- Robert Ethan Applebaum, M.D.
- Stephanie Harris Applebaum, M.D.
- Arrow Defined Therapeutic Services, LLC
- Ascend
- Ronnie A Ata, DDS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; 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.