Michele T Bogacki, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

4452 N Central Ave
Chicago, IL 60630-3302

Phone

(773) 777-4800

Fax

(773) 777-4918

NPI assigned

Jul 26, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Michele T Bogacki DDS, LTD.

  • Dental Clinic/Center
  • Chicago, IL
  • NPI 1528081965
  NPD (past) Authorized official
• Jefferson Park Family Dental LLC

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1417528589
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528081742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4452 N CENTRAL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606303302",
            "telephone_number": "773-777-4800",
            "fax_number": "773-777-4918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4452 N CENTRAL AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606303302",
            "telephone_number": "773-777-4800",
            "fax_number": "773-777-4918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGACKI",
        "first_name": "MICHELE",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey L Boetto, DNP, FNP-C
• Boffa Medical Group LLC (Boffa Surgical Group, LLC)
• James Frank Boffa, M.D.
• Margaret Marie Boffa, MT-BC
• Catherine Bogacki
• Corrin Renee Bogan
• Crystal L Bogan
• Avery May Bogart
• Isabel Grace Bogart, LPC
• Lynnsey Nicole Bogash, RD, LDN

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.