Individual provider Active NPI

Matthew Leon Blass, DDS

  • Dentist
  • Elmhurst, IL
National Provider Identifier
1508970526
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Practice address
129 E Vallette Street
Elmhurst, IL 60126-4477
Phone
(630) 834-0663
Fax
(630) 834-2434
NPI assigned
Aug 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X IL Primary

Addresses

Primary practice location

129 E Vallette Street
Elmhurst, IL 60126-4477

Mailing address

129 E Vallette Street
Elmhurst, IL 60126-4477
Phone (630) 834-0663

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
I20141217002072 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6204159528

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Peter J Chiaculas DPM PC 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": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508970526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 E VALLETTE STREET",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601264477",
            "telephone_number": "630-834-0663",
            "fax_number": "630-834-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 E VALLETTE STREET",
            "city": "ELMHURST",
            "state": "IL",
            "postal_code": "601264477",
            "telephone_number": "630-834-0663",
            "fax_number": "630-834-2434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLASS",
        "first_name": "MATTHEW",
        "middle_name": "LEON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmhurst, IL

Sources for this page

Verify at the official NPI Registry.