Individual provider Active NPI

Patrick Ryan Tham, D.D.S.

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1548699119
Registry record updated Jan 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019.029691 Issued in IL
Practice address
9119 S Exchange Ave
Chicago, IL 60617-4225
Phone
(773) 768-5000
NPI assigned
Nov 4, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019.029691 IL Primary

Addresses

Primary practice location

9119 S Exchange Ave
Chicago, IL 60617-4225

Mailing address

9119 S Exchange Ave
Chicago, IL 60617-4225
Phone (773) 768-5000

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
I20160111000044 IL Practitioner - DentistPractitioner - Oral Surgery 9335441245 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.029691ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Erie Family Health Center, Inc Current Accepting new patients
Erie Family Health Center Inc CurrentSince Aug 8, 2022 Accepting new patients
Erie Family Health Center Inc. CurrentSince Aug 8, 2022 Accepting new patients

Locations

1701 W Superior St
Chicago, IL 60622
Phone (312) 432-7392

1504 S Albany Ave
Chicago, IL 60623

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-7381

Interoperability endpoints

  • Direct secure messaging: ptham588804@direct.ochin.org

Organizations & group practices 3

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": "1383523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452038400000",
    "number": "1548699119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9119 S EXCHANGE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174225",
            "telephone_number": "773-768-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9119 S EXCHANGE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174225",
            "telephone_number": "773-768-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAM",
        "first_name": "PATRICK",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-04",
        "last_updated": "2016-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.029691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.