NPIMap

Individual provider Active NPI

Andy Mancini, DMD, MBA

  • Pediatric Dentistry
  • Bloomington, IL
National Provider Identifier
1487813473
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
021.003238 Issued in IL
Practice address
1407 N Veterans Pkwy
Bloomington, IL 61704-6630
Phone
(309) 661-2999
NPI assigned
Jun 4, 2008
Last updated
May 21, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019.033956 IL
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 019.033956 IL
Pediatric Dentistry 1223P0221X 021.003238 IL Primary

Addresses

Primary practice location

1407 N Veterans Pkwy
Bloomington, IL 61704-6630

Mailing address

2841 N 73Rd CT
Elmwood Park, IL 60707-1523
Phone (954) 789-5099

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
Credentials
Master of Business Administration

State licenses

LicenseStateTypeSpecialty
019.033956ILMDPediatric Dentist
021.003238ILMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Hause PLLC Current Accepting new patients
La Petite Dentistry Pediatric Dentistry 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1212537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716249600000",
    "number": "1487813473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2841 N 73RD CT",
            "city": "ELMWOOD PARK",
            "state": "IL",
            "postal_code": "607071523",
            "telephone_number": "954-789-5099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 N VETERANS PKWY",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046630",
            "telephone_number": "309-661-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCINI",
        "first_name": "ANDY",
        "name_prefix": "Dr.",
        "credential": "DMD, MBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-04",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.033956",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "019.033956",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": "021.003238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.