Alaa Alshair, BDS, CAGS, MSCD
Individual provider Active NPI Dentist · Anna, IL
NPI 1508519281 · NPPES record last updated Sep 6, 2023
Key facts
- NPI
- 1508519281
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.033480 (IL)
- Practice address
- 513 N Main St
Anna, IL 62906-1697 - Phone
- (618) 833-4475
- NPI assigned
- Feb 1, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231031001586 | IL | Practitioner - Dentist | 3577919364 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-033480 | IL | MD | Dentist |
| 019.033480 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rural Health, Inc. | Current |
Accepting new patients | |
| Rural Health, Inc. | Current |
Accepting new patients | |
| Familia Dental Moline LLC | Past |
Accepting new patients |
Locations
513 N Main St
Anna, IL 62906
Phone (618) 833-4471
211 N Broadway
Goreville, IL 62939
Phone (618) 995-1002
Interoperability endpoints
- alaa.alshair.1@7601.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019-033480 | IL | |
| Dentist | 122300000X | 019.033480 | IL | Yes |
Addresses
Primary practice location
513 N Main St
Anna, IL 62906-1697
Mailing address
513 N Main St
Anna, IL 62906-1697
Phone (618) 833-4475
Other providers in Anna, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.