Jason Alan Fowler, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

61748 Issued in CA

Practice address

2410 Sampson St
BLDG. 237
Great Lakes, IL 60088-2942

Phone

(847) 688-3331

NPI assigned

Aug 16, 2012

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345075200000",
    "number": "1417205873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 EUCALYPTUS DR",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923737126",
            "telephone_number": "909-709-6932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 SAMPSON ST",
            "address_2": "BLDG. 237",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "600882942",
            "telephone_number": "847-688-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "JASON",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-16",
        "last_updated": "2012-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Philip Fee, DDS
• Luis Victor Fernandez
• Timothy Paul Fitzharris, DDS
• Richard Flynn
• Joseph J. Ford Jr., MSW
• Robert Kurt Frisk, DDS
• Edward Raymond Frye, LCSW
• Evan Fuchs
• John Allan Clayton Fulling, IDC
• Deborah Jeanne Galen, M.D.

• Dentist in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; 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.