Individual provider Active NPI

Adnan D Atcha, DMD

  • Dentist
  • Chicago, IL
National Provider Identifier
1477613586
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Practice address
7185 W Grand Ave
Chicago, IL 60707
Phone
(773) 622-1818
Fax
(773) 622-8370
NPI assigned
Dec 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X IL Primary

Addresses

Primary practice location

7185 W Grand Ave
Chicago, IL 60707

Mailing address

7185 W Grand Ave
Chicago, IL 60707
Phone (773) 622-1818

Other identifiers 1

IdentifierTypeStateIssuer
1004377MedicaidIL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160614001335 IL Order and Referring Only - DentistPractitioner - Dentist 6901197458

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019024819ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Montclare Dental Inc Dentist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477613586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7185 W GRAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60707",
            "telephone_number": "773-622-1818",
            "fax_number": "773-622-8370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7185 W GRAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60707",
            "telephone_number": "773-622-1818",
            "fax_number": "773-622-8370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATCHA",
        "first_name": "ADNAN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004377",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.