Individual provider Active NPI

Steven J Mahany, DMD

  • General Practice Dentistry
  • Peoria, IL
National Provider Identifier
1619059268
Registry record updated Jun 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019017232 Issued in IL
Practice address
9016 N Allen Rd
Suite B
Peoria, IL 61615-1513
Phone
(309) 690-4500
Fax
(309) 691-7298
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2012

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 019017232 IL Primary

Addresses

Primary practice location

9016 N Allen Rd
Suite B
Peoria, IL 61615-1513

Mailing address

11407 N Route 91
Dunlap, IL 61525-9218
Phone (309) 243-7054

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

State licenses

LicenseStateTypeSpecialty
019017232ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Associates in Dentistry 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.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338508800000",
    "number": "1619059268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11407 N ROUTE 91",
            "city": "DUNLAP",
            "state": "IL",
            "postal_code": "615259218",
            "telephone_number": "309-243-7054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9016 N ALLEN RD",
            "address_2": "SUITE B",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616151513",
            "telephone_number": "309-690-4500",
            "fax_number": "309-691-7298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHANY",
        "first_name": "STEVEN",
        "middle_name": "J",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2012-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019017232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2012; 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.