Active NPI
Lori Trentacosti, REGISTERED DIETICIAN
- Registered Dietitian
- Carbondale, IL
National Provider Identifier
1508913427
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 164-000649
- Practice address
- 2601 W Main St
Carbondale, IL 62901-1031 - Phone
- (618) 549-5361
- Fax
- (618) 549-5128
- NPI assigned
- Jan 4, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 164-000649 | IL | Primary |
Addresses
Primary practice location
2601 W Main St
Carbondale, IL 62901-1031
Mailing address
PO Box 1105
Indianapolis, IN 46206-1105
Phone (618) 549-5361
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 203887 | Other | IL | LEGACY |
| 7210895 | Other | IL | AETNA |
| 078833 | Other | IL | HEALTH ALLIANCE |
| 3932056 | Other | IL | BCBS OF IL |
| 710000734 | Other | IL | RR MEDICARE |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164-000649 | IL | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209772800000",
"number": "1508913427",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1105",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462061105",
"telephone_number": "618-549-5361",
"fax_number": "618-549-5128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2601 W MAIN ST",
"city": "CARBONDALE",
"state": "IL",
"postal_code": "629011031",
"telephone_number": "618-549-5361",
"fax_number": "618-549-5128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRENTACOSTI",
"first_name": "LORI",
"name_prefix": "Ms.",
"credential": "REGISTERED DIETICIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-04",
"last_updated": "2008-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IL",
"license": "164-000649",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LEGACY",
"identifier": "203887",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7210895",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "078833",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF IL",
"identifier": "3932056",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "710000734",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carbondale, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.