Individual provider Active NPI

Kara Lynn Schreder, D.M.D.

  • General Practice Dentistry
  • O Fallon, IL
National Provider Identifier
1285788356
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019025108 Issued in IL
Practice address
741 W State St
Suite 1
O Fallon, IL 62269-1971
Phone
(618) 632-2282
NPI assigned
Jan 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 019025108 IL Primary

Addresses

Primary practice location

741 W State St
Suite 1
O Fallon, IL 62269-1971

Mailing address

741 W State St
Suite 1
O Fallon, IL 62269-1971

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151105001769 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8527378462

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Dental Studio of Southern Illinois PastSince Apr 17, 2022 Accepting new patients
Bowman Dental Group General Practice Past Accepting new patients

Organizations & group practices 2

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": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285788356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 W STATE ST",
            "address_2": "SUITE 1",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741 W STATE ST",
            "address_2": "SUITE 1",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691971",
            "telephone_number": "618-632-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHREDER",
        "first_name": "KARA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O Fallon, IL

Sources for this page

Verify at the official NPI Registry.