Active NPI
Shadi Mohebi
- Orthodontics and Dentofacial Orthopedics Dentistry
- Champaign, IL
National Provider Identifier
1457199689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- DL15906
- Practice address
- 1715 Broadmoor Dr Ste a
Champaign, IL 61821-5984 - Phone
- (217) 886-8217
- NPI assigned
- Jul 20, 2024
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DL15906 | MA | Primary |
Addresses
Primary practice location
1715 Broadmoor Dr Ste a
Champaign, IL 61821-5984
Mailing address
4008 Turnberry Dr
Champaign, IL 61822-8512
Phone (216) 835-6067
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DL15906 | MA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721433600000",
"number": "1457199689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4008 TURNBERRY DR",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618228512",
"telephone_number": "216-835-6067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1715 BROADMOOR DR STE A",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618215984",
"telephone_number": "217-886-8217"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOHEBI",
"first_name": "SHADI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-07-20",
"last_updated": "2024-07-20",
"certification_date": "2024-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MA",
"license": "DL15906",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.