Chad Ryan Wiersema, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

021002195 Issued in IL

Practice address

18130 Halsted St
Homewood, IL 60430-2507

Phone

(708) 799-2550

NPI assigned

Dec 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

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.

• Endodontic & Periodontic Associates, LTD

  • Endodontics
  • Homewood, IL
  • NPI 1013075480
  NPD (past)
• Grove Dental Associates., P.C.

  • Dentist
  • Downers Grove, IL
  • NPI 1841378015
  NPD (past)

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330560000000",
    "number": "1427114115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18130 HALSTED ST",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302507",
            "telephone_number": "708-799-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18130 HALSTED ST",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302507",
            "telephone_number": "708-799-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIERSEMA",
        "first_name": "CHAD",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2012-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019026244",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010886A",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": "021002195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacqueline D White, MD
• Leslie White
• Nicholas Treymane White
• Phyllis Lynn White, M. A., M. DIV., LMFT
• Nicole Marie Whitten, APRN
• Ellen Agnes Wiggins, LCSW
• Danielle N Wilkins-Travis
• Penny Will
• Brooke A Williams
• Felicia Inez Williams, M.A.,LCPC

• Endodontics in Homewood, IL
• Providers in Homewood, IL by specialty
• Endodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.