Active NPI
Hetal B Patel, DDS
- Dentist
- Chicago, IL
National Provider Identifier
1528264090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Practice address
- 4642 S Damen Ave
Chicago, IL 60609-4043 - Phone
- (773) 869-0200
- NPI assigned
- Jun 22, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | IL | Primary |
Addresses
Primary practice location
4642 S Damen Ave
Chicago, IL 60609-4043
Mailing address
430 W Erie St
Suite 500
Chicago, IL 60610-6914
Phone (312) 274-0308
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160506001171 | IL | Order and Referring Only - Other (Physician) | 3072812460 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019027323 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528264090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 W ERIE ST",
"address_2": "SUITE 500",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606106914",
"telephone_number": "312-274-0308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4642 S DAMEN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606094043",
"telephone_number": "773-869-0200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATEL",
"first_name": "HETAL",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-22",
"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 Chicago, IL
Sources for this page
- 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.