Active NPI
Joshua Hermanson
- General Practice Dentistry
- Loves Park, IL
National Provider Identifier
1477906345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.030835
- Practice address
- 2028 E Riverside Blvd
Suite 210
Loves Park, IL 61111-4804 - Phone
- (815) 877-4300
- NPI assigned
- Jul 15, 2016
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.030835 | IL | Primary |
Addresses
Primary practice location
2028 E Riverside Blvd
Suite 210
Loves Park, IL 61111-4804
Mailing address
2028 E Riverside Blvd
Suite 210
Loves Park, IL 61111-4804
Phone (815) 877-4300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019.030835 | Other | IL | DENTIST |
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 |
|---|---|---|---|
| 019.030835 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Riverside Dental Center | General Practice | Past | Accepting new patients |
| Riverside Dental Center GPS PLLC | General Practice | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- General Practice Dentistry
- Loves Park, IL
- NPI 1811862196
General Practice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468540800000",
"number": "1477906345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2028 E RIVERSIDE BLVD",
"address_2": "SUITE 210",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611114804",
"telephone_number": "815-877-4300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2028 E RIVERSIDE BLVD",
"address_2": "SUITE 210",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611114804",
"telephone_number": "815-877-4300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERMANSON",
"first_name": "JOSHUA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-15",
"last_updated": "2016-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.030835",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTIST",
"identifier": "019.030835",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Loves Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.