NPIMap

Individual provider Active NPI

John Mantinaos, DMD

  • Dentist
  • Quincy, IL
National Provider Identifier
1639328677
Registry record updated Oct 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019028483 Issued in IL
Practice address
5203 Broadway St
Quincy, IL 62305-9110
Phone
(217) 577-2400
Fax
(217) 228-1032
NPI assigned
Sep 15, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2014

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 048817-1 NY
Dentist 122300000X 12011569A IN
Dentist 122300000X 019028483 IL Primary
Dentist 122300000X 22DI02373800 NJ
Dentist 122300000X DS036424 PA
Dentist 122300000X DN20160 MA

Addresses

Primary practice location

5203 Broadway St
Quincy, IL 62305-9110

Mailing address

5203 Broadway St
Quincy, IL 62305-9110
Phone (217) 577-2400

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
019028483ILMDDentist
12011569AINMDDentist
DN20160MAMDDentist
22DI02373800NJMDDentist
048817-1NYMDDentist
DS036424PAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
County of Whiteside Dentist Past Accepting new patients
Shamim Amin Dental PLLC Past Accepting new patients
County of Whiteside Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: john.mantinaos.d1.p16@direct.fhn-fqhc.nextgenshare.com

Organizations & group practices 3

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": "1221436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414022400000",
    "number": "1639328677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5203 BROADWAY ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623059110",
            "telephone_number": "217-577-2400",
            "fax_number": "217-228-1032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5203 BROADWAY ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623059110",
            "telephone_number": "217-577-2400",
            "fax_number": "217-228-1032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTINAOS",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-15",
        "last_updated": "2014-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "048817-1",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011569A",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028483",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02373800",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS036424",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN20160",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; 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.