Active NPI
Todd J Cole, DDS
- Dentist
- Mt Zion, IL
National Provider Identifier
1336134097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019-023602
- Practice address
- 210 Casa Park Dr
Mt Zion, IL 62549-1757 - Phone
- (217) 864-6016
- NPI assigned
- Sep 19, 2005
- Last updated
- Dec 13, 2014
- 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 | 019-023602 | IL | Primary |
Addresses
Primary practice location
210 Casa Park Dr
Mt Zion, IL 62549-1757
Mailing address
2602 Lake Reunion Rd
Decatur, IL 62521-8407
Phone (217) 423-0607
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: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150505001826 | IL | Order and Referring Only - Other (Non-Physician) | 2860711355 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-023602 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418428800000",
"number": "1336134097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2602 LAKE REUNION RD",
"city": "DECATUR",
"state": "IL",
"postal_code": "625218407",
"telephone_number": "217-423-0607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 CASA PARK DR",
"city": "MT ZION",
"state": "IL",
"postal_code": "625491757",
"telephone_number": "217-864-6016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLE",
"first_name": "TODD",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-19",
"last_updated": "2014-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019-023602",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mt Zion, IL
- Timothy Delbert Busey, OD
- Tina L Calhoun
- Holly Marie Chapman, APN
- Christopher J Woodrow, D.C., P.C. (Mt Zion Chiropractic Center)
- Tosha Cobb, LMT
- Decatur Family Medical Group Inc (Cornerstone Family Medical Center)
- Decatur Orthopedic Center, LLC
- Decatur Orthopedic Center, LLC
- Decatur Orthopedic Center, LLC
- Dolly Briscoe Enterprises, Inc. (Physician's Choice Wellness)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 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.