Eliane Fossatti Goncalves, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019032815 Issued in IL

Practice address

802 N 9TH St
Springfield, IL 62702-6309

Phone

(217) 679-2896

NPI assigned

Jul 20, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: eliane.goncalves.p1@direct.chccmo.nextgenshare.com

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

{
    "created_epoch": "1595203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1588272140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 N 9TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627026309",
            "telephone_number": "217-679-2896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 N 9TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627026309",
            "telephone_number": "217-679-2896"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "821 Westwood Dr",
            "address_purpose": "LOCATION",
            "city": "Sedalia",
            "state": "MO",
            "postal_code": "653012102",
            "country_code": "US",
            "telephone_number": "660-826-4774",
            "fax_number": "888-979-8868",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOSSATTI GONCALVES",
        "first_name": "ELIANE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-20",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019032815",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2021020128",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawna Megan Forinash, LCSW
• Megan J Forshee, D.O.
• Fort Health Medical Group PA
• Forum Extended Care Services of Central Illinois
• Angela Fay Foshage Johnson, O.D.
• Michaelia Vasilia Fosses Vuong, DO
• Anne O'Brien Foster, NP-C
• Ashlee Foster, FNP
• Dylan Foster
• Emily Sue Foster, OTRL

• General Practice Dentistry in Springfield, IL
• Providers in Springfield, 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 Jun 23, 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.

Verify at the official NPI Registry.