Jack Glenn Walz, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019021995 Issued in IL

Practice address

731 Sabrina Drive
Ste a
East Peoria, IL 61611

Phone

(309) 699-1300

Fax

(309) 699-5399

NPI assigned

Aug 25, 2006

Last updated

Mar 12, 2018By 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

Specialty

Oral Surgery

Education

Other, 1981

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Central Illinois Center for TMJ and Facial Pain PC

  dba TMJ & Sleep Apnea Center of Central IL

  • Dentist
  • East Peoria, IL
  • NPI 1962745232
  Medicare reassignment Authorized official
• Saint Francis Medical Center

  dba Physical Medicine & Rehabilitation

  • Physical Medicine & Rehabilitation Physician
  • Peoria, IL
  • NPI 1023062312
  Medicare reassignment NPD
• Central Illinois Center for TMJ and Facial Pain, P.C.

  • Dentist
  • East Peoria, IL
  • NPI 1346546421
  NPD Authorized official
• Saint Francis Medical Center

  dba Saint Francis Home Health

  • Home Health Agency
  • Peoria, IL
  • NPI 1346281425
  NPD
• Saint Francis Medical Center

  dba Multiple Hospital Departments

  • Nurse Practitioner
  • Peoria, IL
  • NPI 1962456764
  NPD
• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520812800000",
    "number": "1427166008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 SABRINA DR",
            "address_2": "UNIT A",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616113582",
            "telephone_number": "309-699-1300",
            "fax_number": "309-699-5399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 SABRINA DRIVE",
            "address_2": "STE A",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "61611",
            "telephone_number": "309-699-1300",
            "fax_number": "309-699-5399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALZ",
        "first_name": "JACK",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2018-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019021995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walker Caring Hands LLC
• Christopher Walker, BA
• Walmart Inc.
• Kelsee Walsh, ATC
• Mallory Walters, BCBA
• Michael Christopher Walz, D.C.
• Christopher Webb, DMD
• William Greg Weinman, D.C.
• Nathan Wenzel, PHARMD, MS
• Tyler Werner, PHARMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.