Kashyap Maddali, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.029910 Issued in IL

Practice address

1301 N Alpine Rd
Rockford, IL 61107-2262

Phone

(815) 397-4280

Fax

(815) 484-2436

NPI assigned

Jul 9, 2014

Last updated

Jul 9, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404864000000",
    "number": "1316353477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 N ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611072262",
            "telephone_number": "815-397-4280",
            "fax_number": "815-484-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 N ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611072262",
            "telephone_number": "815-397-4280",
            "fax_number": "815-484-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADDALI",
        "first_name": "KASHYAP",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-09",
        "last_updated": "2014-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.029910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sean P Mackenzie, M.D.
• Debra Mackey, RN
• Amanda Macquoid, MD
• Catherine J Maculan, DACBSP
• Samragnyi Madala, MD
• Teri Madden
• Made Essential (Made Essential Transportation)
• Madison Vamc
• Madison Vamc
• Andrew Maduakor

• General Practice Dentistry in Rockford, IL
• Providers in Rockford, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; 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.

Verify at the official NPI Registry.