Robert Kenton Gilmore, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

019023687 Issued in IL

Practice address

4408 N Knoxville Ave
Suite D
Peoria, IL 61614-6084

Phone

(309) 682-5522

Fax

(309) 682-7698

NPI assigned

Jun 6, 2014

Last updated

Jun 6, 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

Practice roles

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.

• Carla C. Couri, D.M.D., LTD.

  • General Practice Dentistry
  • Peoria, IL
  • NPI 1457554552
  NPD (past)

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

{
    "created_epoch": "1402012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402012800000",
    "number": "1376956441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4408 N. KNOXVILLE, SUITE D",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616146084",
            "telephone_number": "309-682-5522",
            "fax_number": "309-682-7698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4408 N KNOXVILLE AVE",
            "address_2": "SUITE D",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616146084",
            "telephone_number": "309-682-5522",
            "fax_number": "309-682-7698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILMORE",
        "first_name": "ROBERT",
        "middle_name": "KENTON",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-06",
        "last_updated": "2014-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019023687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Gilles, LCSW
• Christopher Michael Gillette, PHARM D., BCPP
• Keri M Gillette, COTA
• Cynthia L Gilmer, LCSW
• Karen Leslie Gilmore, LCSW
• Amanda Gilmour, NP
• Cynthia J Ginder, P.T.
• Carrie Christine Gingerich
• Metyl A Ginoli, N.P.
• Alan S Ginzburg, MD

• Dentist in Peoria, IL
• Providers in Peoria, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.