Active NPI
Charlotte Sunaina Jakkula
- Dentist
- Peoria, IL
National Provider Identifier
1386161248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019031374
- Practice address
- 1403 W Glen Ave
Peoria, IL 61614-4705 - Phone
- (888) 988-4066
- NPI assigned
- Aug 23, 2017
- Last updated
- Aug 23, 2017
- Sex
- Female
- Sole proprietor
- No
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 | 019031374 | IL | Primary |
Addresses
Primary practice location
1403 W Glen Ave
Peoria, IL 61614-4705
Mailing address
2050 E Algonquin Rd Ste 610
Schaumburg, IL 60173-4166
Phone (888) 988-4066
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170927002252 | IL | Order and Referring Only - Dentist | 9032483235 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019031374 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503446400000",
"number": "1386161248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2050 E ALGONQUIN RD STE 610",
"city": "SCHAUMBURG",
"state": "IL",
"postal_code": "601734166",
"telephone_number": "888-988-4066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1403 W GLEN AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616144705",
"telephone_number": "888-988-4066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JAKKULA",
"first_name": "CHARLOTTE",
"middle_name": "SUNAINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-23",
"last_updated": "2017-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019031374",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
- Nazish Hasan Jafri, D.D.S.
- Sarath Kumar Jaganathan Jaishankar, MD
- Matthew D Jager, D.O.
- Jaimee York PLLC (Arthur Layne Counseling Services)
- Jak Enterprises Dba Jak Optical Laboratories (JAK Optical Laboratories)
- Ahmed Tejan Jalloh Jr., MD
- Lynne Marie Jalovec, M.D.
- James J Malavolti DC LLC (Malavolti Chiropractic Center)
- James K Crane MDSC
- James L. Swingler M.D. Gynecology & Obstetrics S.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2017; 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.