Active NPI
John Perisin
- Dentist
- St Charles, IL
National Provider Identifier
1619538485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.032202
- Practice address
- 516 E Main St
St Charles, IL 60174-2133 - Phone
- (630) 377-3131
- NPI assigned
- Jun 24, 2019
- Last updated
- Jul 6, 2023
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019.032202 | IL | Primary |
Addresses
Primary practice location
516 E Main St
St Charles, IL 60174-2133
Mailing address
106 E Hanover PL
Peoria, IL 61614-2120
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
| License | State | Type | Specialty |
|---|---|---|---|
| 019.032202 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John F. Perisin DMD P.C. | Current | Accepting new patients | |
| Batavia Dental PC | Dentist | Current | Accepting new patients |
Locations
516 E Main St
St Charles, IL 60174
Phone (630) 377-3131
Organizations & group practices 2
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.
-
- Dentist
- Batavia, IL
- NPI 1306796933
-
dba St. Charles Family Dentistry
- General Practice Dentistry
- St Charles, IL
- NPI 1205531431
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688601600000",
"number": "1619538485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 E HANOVER PL",
"city": "PEORIA",
"state": "IL",
"postal_code": "616142120"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "516 E MAIN ST",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601742133",
"telephone_number": "630-377-3131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERISIN",
"first_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-06-24",
"last_updated": "2023-07-06",
"certification_date": "2023-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.032202",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Charles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.