Active NPI
Sara Renee Rauen Dardis, DDS, MS
- Pediatric Dentistry
- Bloomington, IL
National Provider Identifier
1558465583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 021002032
- Practice address
- 211 S Prospect Rd
Bloomington, IL 61704-4910 - Phone
- (309) 663-7339
- Fax
- (309) 663-7173
- NPI assigned
- Sep 11, 2006
- Last updated
- Feb 12, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019025801 | IL | |
| Pediatric Dentistry | 1223P0221X | 021002032 | IL | Primary |
Addresses
Primary practice location
211 S Prospect Rd
Bloomington, IL 61704-4910
Mailing address
1112 Trinity LN
Bloomington, IL 61704-8109
Phone (309) 663-7339
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000029040 | Other | BLUECROSSBLUESHIELD FEDERAL |
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019025801 | IL | MD | General Practice Dentistry |
| 021002032 | IL | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Dental Associates of McLean County, Inc | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Bloomington, IL
- NPI 1982878708
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613088000000",
"number": "1558465583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1112 TRINITY LN",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617048109",
"telephone_number": "309-663-7339",
"fax_number": "309-663-7173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 S PROSPECT RD",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617044910",
"telephone_number": "309-663-7339",
"fax_number": "309-663-7173"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAUEN DARDIS",
"first_name": "SARA",
"middle_name": "RENEE",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-11",
"last_updated": "2021-02-12",
"certification_date": "2021-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019025801",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "IL",
"license": "021002032",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD FEDERAL",
"identifier": "0000029040",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.