Andrew Gene Caldieraro, DMD
Individual provider Active NPI Dentist · Mattoon, IL
NPI 1619259470 · NPPES record last updated Sep 16, 2011
Key facts
- NPI
- 1619259470
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.028821 (IL)
- Practice address
- 1011 Charleston Ave E
Mattoon, IL 61938-6226 - Phone
- (217) 235-5900
- NPI assigned
- Sep 16, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL, MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230801002026 | IL | Practitioner - Dentist | 8123329000 | Reassigns benefits to 1 organization |
| I20230823001516 | MO | Practitioner - Dentist | 8123329000 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.028821 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aria Dental Care PC | Dentist | Current |
Accepting new patients |
Locations
901 S 2nd St
Ste 201
Springfield, IL 62704
Phone (312) 560-2917
8500 W 110th St
Ste 450
Overland Park, KS 66210
Phone (913) 362-1112
2847 S Ingram Mill Rd
Ste A100
Springfield, MO 65804
Phone (214) 705-2301
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.028821 | IL | Yes |
Addresses
Primary practice location
1011 Charleston Ave E
Mattoon, IL 61938-6226
Mailing address
1011 Charleston Ave E
Mattoon, IL 61938-6226
Other providers in Mattoon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.