Active NPI
Maria G Patino, D.D.S, M.S.
- Periodontics
- Chicago, IL
National Provider Identifier
1669489118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 019-026187
- Practice address
- 1411 W Irving Park Rd
Chicago, IL 60613-1920 - Phone
- (773) 404-8030
- NPI assigned
- Aug 1, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 019-026187 | IL | Primary |
Addresses
Primary practice location
1411 W Irving Park Rd
Chicago, IL 60613-1920
Mailing address
125 E 13TH St
Unit 1405
Chicago, IL 60605-2655
Phone (312) 834-0521
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- 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 |
|---|---|---|---|---|
| I20160513000836 | IL | Order and Referring Only - Other (Physician) | 8426347485 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-026187 | IL | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669489118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "125 E 13TH ST",
"address_2": "UNIT 1405",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606052655",
"telephone_number": "312-834-0521"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 W IRVING PARK RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606131920",
"telephone_number": "773-404-8030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATINO",
"first_name": "MARIA",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "D.D.S, M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": "019-026187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.