Active NPI
Richard Flynn
- Dentist
- Great Lakes, IL
National Provider Identifier
1467971119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 33479
- Practice address
- 3440 Ohio St
Great Lakes, IL 60088-3155 - Phone
- (847) 688-2100
- NPI assigned
- Sep 13, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 33479 | TX | Primary |
Addresses
Primary practice location
3440 Ohio St
Great Lakes, IL 60088-3155
Mailing address
42 Farmside Dr
Pembroke, MA 02359-1727
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220726002593 | KY | Order and Referring Only - Dentist | 2163804972 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33479 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1505260800000",
"number": "1467971119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42 FARMSIDE DR",
"city": "PEMBROKE",
"state": "MA",
"postal_code": "023591727"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3440 OHIO ST",
"city": "GREAT LAKES",
"state": "IL",
"postal_code": "600883155",
"telephone_number": "847-688-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLYNN",
"first_name": "RICHARD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-09-13",
"last_updated": "2017-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "33479",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Lakes, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2017; 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.