Individual provider Active NPI

Anthony L. Griglione, D.M.D.

  • Endodontics
  • Homewood, IL
National Provider Identifier
1508177239
Registry record updated Jun 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
021002553 Issued in IL
Practice address
18130 Halsted St
Homewood, IL 60430
Phone
(708) 799-2550
NPI assigned
Jun 28, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2010018660 MO
Endodontics 1223E0200X 021002553 IL Primary

Addresses

Primary practice location

18130 Halsted St
Homewood, IL 60430

Mailing address

18130 Halsted St
Homewood, IL 60430-2507
Phone (708) 799-2550

Other practice location 1

13035 Olive Blvd
Suite 214
Saint Louis, MO 63141-6173
Phone (314) 205-0111

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
I20130814000617 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0941442313

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
021002553ILMDEndodontist
2010018660MOMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Endodontic & Periodontic Associates, LTD Endodontics 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": "1277683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561680000000",
    "number": "1508177239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18130 HALSTED ST",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "604302507",
            "telephone_number": "708-799-2550",
            "fax_number": "708-799-7680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18130 HALSTED ST",
            "city": "HOMEWOOD",
            "state": "IL",
            "postal_code": "60430",
            "telephone_number": "708-799-2550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13035 Olive Blvd",
            "address_2": "Suite 214",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631416173",
            "country_code": "US",
            "telephone_number": "314-205-0111",
            "fax_number": "314-205-0777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRIGLIONE",
        "first_name": "ANTHONY",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-28",
        "last_updated": "2019-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2010018660",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": "021002553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Homewood, IL

Sources for this page

Verify at the official NPI Registry.