Active NPI
Austin Alexander Potrue, DMD
- Dentist
- Lincolnwood, IL
National Provider Identifier
1235869991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.033722
- Practice address
- 4368 W Touhy Ave
Lincolnwood, IL 60712-1927 - Phone
- (847) 610-9272
- NPI assigned
- Jun 15, 2022
- Sex
- Male
- Sole proprietor
- Yes
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 | 019.033722 | IL | Primary |
Addresses
Primary practice location
4368 W Touhy Ave
Lincolnwood, IL 60712-1927
Mailing address
406 Claret Dr
Buffalo Grove, IL 60089-1785
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: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230920003394 | IL | Order and Referring Only - Dentist | 4486008729 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.033722 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SB Family Dental LLC | Current | Accepting new patients |
Locations
4368 W Touhy Ave
Lincolnwood, IL 60712
Phone (708) 769-0853
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655251200000",
"number": "1235869991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 CLARET DR",
"city": "BUFFALO GROVE",
"state": "IL",
"postal_code": "600891785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4368 W TOUHY AVE",
"city": "LINCOLNWOOD",
"state": "IL",
"postal_code": "607121927",
"telephone_number": "847-610-9272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTRUE",
"first_name": "AUSTIN",
"middle_name": "ALEXANDER",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-15",
"last_updated": "2022-06-15",
"certification_date": "2022-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist",
"state": "IL",
"license": "019.033722",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincolnwood, IL
- Michal A. Piszczuk, DPM, PHARMD, RPH
- Platinum Home Health Services Inc.
- Podiatric Management Systems LLC (Bradley S Ross DPM)
- Howard S. Pollack, M.S.W
- Rachel Porritt, M.S., CCC-SLP
- Precision Therapy
- Premier Podiatry Services, LTD
- Premium Home Health Care, Inc.
- Prime Care Home Health Services LLC
- Primecare Home Health Services Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; 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.