Active NPI
Nissa Ophaso, DMD
- General Practice Dentistry
- Schaumburg, IL
National Provider Identifier
1609280395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DD4109
- Practice address
- 2050 E Algonquin Rd
Ste 610
Schaumburg, IL 60173-4144 - Phone
- (847) 701-1455
- NPI assigned
- Jun 20, 2014
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DD4109 | NM | Primary |
Addresses
Primary practice location
2050 E Algonquin Rd
Ste 610
Schaumburg, IL 60173-4144
Mailing address
1701 Joe Harvey Blvd
Ste B
Hobbs, NM 88240
Phone (847) 701-1455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
- 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 |
|---|---|---|---|---|
| I20150819009189 | NM | Order and Referring Only - Oral Surgery | 1052626017 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD4109 | NM | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| HST PLLC | General Practice | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403222400000",
"number": "1609280395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1701 JOE HARVEY BLVD",
"address_2": "STE B",
"city": "HOBBS",
"state": "NM",
"postal_code": "88240",
"telephone_number": "847-701-1455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2050 E ALGONQUIN RD",
"address_2": "STE 610",
"city": "SCHAUMBURG",
"state": "IL",
"postal_code": "601734144",
"telephone_number": "847-701-1455"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OPHASO",
"first_name": "NISSA",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-20",
"last_updated": "2014-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NM",
"license": "DD4109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Schaumburg, IL
- Once Upon Rehabilitation Services II Inc
- Once Upon Rehabilitation Services LLC (Ours ABA)
- Onlinecarecom LLC
- Open Advanced MRI of Schaumburg, LLC
- Open Mind Counseling Services Inc
- Josephine Opoku, MSN, APRN, FNP-C
- Optimeyes Vision Care
- Optimized Life Project Academy, PC
- Optum Healthcare of Illinois, Inc.
- Optum Palliative and Hospice Care, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2014; 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.