Active NPI
Jennifer E Mihalopulos, DMD
- General Practice Dentistry
- Cobden, IL
National Provider Identifier
1700863552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019-026916
- Practice address
- 103 N. Appleknocker
Cobden, IL 62920-2117 - Phone
- (618) 893-4005
- Fax
- (618) 893-1476
- NPI assigned
- Dec 22, 2005
- Reactivated
- May 1, 2006
- Last updated
- May 19, 2008
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019-026916 | IL | Primary |
Addresses
Primary practice location
103 N. Appleknocker
Cobden, IL 62920-2117
Mailing address
513 N Main St
Anna, IL 62906-1668
Phone (618) 833-4471
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019-026916 | Medicaid | IL |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-026916 | IL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rural Health, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1700863552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "513 N MAIN ST",
"city": "ANNA",
"state": "IL",
"postal_code": "629061668",
"telephone_number": "618-833-4471",
"fax_number": "618-833-8878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "103 N. APPLEKNOCKER",
"city": "COBDEN",
"state": "IL",
"postal_code": "629202117",
"telephone_number": "618-893-4005",
"fax_number": "618-893-1476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIHALOPULOS",
"first_name": "JENNIFER",
"middle_name": "E",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-22",
"last_updated": "2008-05-19",
"deactivation_date": "2006-03-31",
"reactivation_date": "2006-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019-026916",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "019-026916",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cobden, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.