Individual provider Active NPI

Imani Jacqueline Behrens, DMD

  • Dentist
  • Chicago, IL
National Provider Identifier
1487396487
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.034166 Issued in IL
Practice address
820 S Wood St.
Suite 100, MC 675
Chicago, IL 60612
Phone
(312) 996-2933
NPI assigned
Apr 11, 2022
Last updated
Jul 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019.034166 IL Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

820 S Wood St.
Suite 100, MC 675
Chicago, IL 60612

Mailing address

820 S Wood St.
Suite 100, MC 675
Chicago, IL 60612
Phone (312) 996-2933

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

LicenseStateTypeSpecialty
019.034166ILMDDentist

Interoperability endpoints

  • Direct secure messaging: ibehrens136817@uihealth.direct-ci.com

NPI Registry JSON

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720742400000",
    "number": "1487396487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 S WOOD ST.",
            "address_2": "SUITE 100, MC 675",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "312-996-2933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 S WOOD ST.",
            "address_2": "SUITE 100, MC 675",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "312-996-2933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEHRENS",
        "first_name": "IMANI",
        "middle_name": "JACQUELINE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-11",
        "last_updated": "2024-07-12",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.034166",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.

Verify at the official NPI Registry.