Stephanie Wagner-Lelevour, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019026616 Issued in IL

Practice address

7447 West Talcott Road
Suite 560
Chicago, IL 60631

Phone

(773) 763-5353

Fax

(773) 573-1232

NPI assigned

May 1, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Petrie Storer & Associates DDS PC

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1730273558
  NPD (past)

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486944000000",
    "number": "1669693388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7447 WEST TALCOTT ROAD",
            "address_2": "SUITE 560",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60631",
            "telephone_number": "773-763-5353",
            "fax_number": "773-573-1232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7447 WEST TALCOTT ROAD",
            "address_2": "SUITE 560",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60631",
            "telephone_number": "773-763-5353",
            "fax_number": "773-573-1232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER-LELEVOUR",
        "first_name": "STEPHANIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2017-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019026616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Waggoner
• Morgan Waggoner, LCPC
• Ajay Wagh
• Taruna Waghray-Penmetcha, M.D
• Rawan Wagiealla, M.D.
• Amanda Wagner, M.ED, RDN, LDN
• Andrew F Wagner, MD
• Chris D Wagner, D.C.
• Elaine Janet Wagner, DC
• Ellen Swiontknowski Wagner, MD

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; 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.

Verify at the official NPI Registry.