Individual provider Active NPI

Steven Barry Raphael, D.D.S.

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1366645657
Registry record updated Apr 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
60491 Issued in KS
Practice address
801 S Paulina St
#301D
Chicago, IL 60612-7210
Phone
(312) 355-3615
NPI assigned
Jun 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2011

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 60491 KS Primary

Addresses

Primary practice location

801 S Paulina St
#301D
Chicago, IL 60612-7210

Mailing address

360 E South Water St
#4102
Chicago, IL 60601-4028
Phone (913) 723-1313

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20140923000085 MO Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0749409803

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
60491KSMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Steven B. Raphael, D.D.S., P.C. Past Accepting new patients

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": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302480000000",
    "number": "1366645657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 E SOUTH WATER ST",
            "address_2": "#4102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606014028",
            "telephone_number": "913-723-1313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S PAULINA ST",
            "address_2": "#301D",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127210",
            "telephone_number": "312-355-3615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAPHAEL",
        "first_name": "STEVEN",
        "middle_name": "BARRY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-06",
        "last_updated": "2011-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "60491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.