NPIMap

Individual provider Active NPI

Brian Andrew Prentice, DDS

  • General Practice Dentistry
  • Lockport, IL
National Provider Identifier
1265442073
Registry record updated Jan 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019.031399 Issued in IL
Practice address
14831 W 159TH St Ste 1
Lockport, IL 60491-9008
Phone
(630) 324-5369
Fax
(815) 744-7059
NPI assigned
Aug 8, 2006
Last updated
Jan 19, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019.031399 IL Primary

Addresses

Primary practice location

14831 W 159TH St Ste 1
Lockport, IL 60491-9008

Mailing address

14831 W 159TH St Ste 1
Lockport, IL 60491-9008
Phone (630) 324-5369

Other identifiers 8

IdentifierTypeStateIssuer
1295165439OtherBARRINGTON SVC LOCATION
1205145554OtherSHOREWOOD SVC LOCATION
1306177241OtherOAKBROOK SVC LOCATION
1760882005OtherSKOKIE SVC LOCATION
F400420356OtherMEDICARE PART B PTAN
F400420355OtherMEDICARE PART B PTAN
P01931253OtherRAILROAD PTAN
1508198474OtherCHICAGO SVC LOCATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171025000011 IL Practitioner - Dentist 3870869555 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dentist
Education
The Dental School at University of Texas HSC at San Antonio, 2001
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

14831 W 159TH St
Suite 1
Homer Glen, IL 60491-9008
Phone (815) 483-2980

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.031399ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Sleep Center Richard a Craig DDS LTD General Practice Current Accepting new patients
Dental Sleep Center Richard a Craig DDS LTD General Practice CurrentSince Sep 11, 2017 Accepting new patients
Dental Sleep Center Richard a Craig DDS LTD General Practice CurrentSince Sep 11, 2017 Accepting new patients

Locations

27790 W Il Route 22
Ste 2
Barrington, IL 60010
Phone (630) 218-1920

150 E Huron St
Ste 1103
Chicago, IL 60611
Phone (312) 676-9893

14831 W 159th St
Ste 1
Lockport, IL 60491
Phone (312) 676-9893

2500 S Highland Ave
Ste 220
Lombard, IL 60148
Phone (630) 218-1920

120 Oakbrook Ctr
Ste 318
Oak Brook, IL 60523
Phone (630) 218-1920

220 Channahon St
Shorewood, IL 60404
Phone (630) 218-1920

4711 Golf Rd
Ste 413
Skokie, IL 60076
Phone (847) 329-9588

7501 Lemont Rd
Ste 300
Woodridge, IL 60517
Phone 6303245369105

Organizations & group practices 3

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1265442073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14831 W 159TH ST STE 1",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604919008",
            "telephone_number": "630-324-5369",
            "fax_number": "815-744-7059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14831 W 159TH ST STE 1",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604919008",
            "telephone_number": "630-324-5369",
            "fax_number": "815-744-7059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRENTICE",
        "first_name": "BRIAN",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.031399",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BARRINGTON SVC LOCATION",
            "identifier": "1295165439",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SHOREWOOD SVC LOCATION",
            "identifier": "1205145554",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OAKBROOK SVC LOCATION",
            "identifier": "1306177241",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SKOKIE SVC LOCATION",
            "identifier": "1760882005",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B PTAN",
            "identifier": "F400420356",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B PTAN",
            "identifier": "F400420355",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PTAN",
            "identifier": "P01931253",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHICAGO SVC LOCATION",
            "identifier": "1508198474",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lockport, IL

Sources for this page

Verify at the official NPI Registry.