Ty Parker, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019027434 Issued in IL

Practice address

314 Fountains Pkwy Ste C
Fairview Heights, IL 62208-2165

Phone

(618) 622-1800

Fax

(618) 466-1433

NPI assigned

Jul 14, 2007

Last updated

Dec 20, 2023By 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.

• Anna R. Smith DMD, PC

  dba Dentistry with TLC

  • General Practice Dentistry
  • Godfrey, IL
  • NPI 1003964081
  NPD (past)
• Larry W. Crocker DMD, PC

  dba Dentistry with TLC

  • General Practice Dentistry
  • Godfrey, IL
  • NPI 1215034608
  NPD (past)
• Ty Parker DMD PC

  dba Fountains Family Dentistry

  • General Practice Dentistry
  • Fairview Heights, IL
  • NPI 1023677069
  NPD (past)

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

{
    "created_epoch": "1184371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1417156951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 FOUNTAINS PKWY STE C",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082165",
            "telephone_number": "618-622-1800",
            "fax_number": "618-466-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 FOUNTAINS PKWY STE C",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082165",
            "telephone_number": "618-622-1800",
            "fax_number": "618-466-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "TY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-14",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Option 1 Nutrition Solutions, LLC (Aveanna Healthcare Medical Solutions - IL)
• Otto Bock Patient Care, LLC
• Ruth Overstreet, OT
• Tyler Christine Owens, LCSW
• Beth M Pacocha Auer, PT, MPT
• Takiera S Parnell
• Federico Parola, M.ED, M.A.
• Caitlyn Patalas, M.S., CCC-SLP
• Pearle Vision Inc (Pearle Vision #C6672)
• Peterson Health Clinic LLC

• General Practice Dentistry in Fairview Heights, IL
• Providers in Fairview Heights, 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 Dec 20, 2023; 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.