Individual provider Active NPI

John F Blattner, D.M.D

  • Customized Equipment (DME)
  • Waterloo, IL
National Provider Identifier
1720008329
Registry record updated Nov 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
License
019016532 Issued in IL
Practice address
226 Westview Plaza Dr.
Waterloo, IL 62298-1253
Phone
(618) 939-4042
Fax
(618) 939-5404
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 21, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 19-016532 IL
Durable Medical Equipment & Medical Supplies 332B00000X 019016532 IL
Customized Equipment (DME) 332BC3200X 019016532 IL Primary

Addresses

Primary practice location

226 Westview Plaza Dr.
Waterloo, IL 62298-1253

Mailing address

226 Westview Plaza Dr.
Waterloo, IL 62298-1253
Phone (618) 939-4042

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170412000228 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 5193041994

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19-016532ILMDGeneral Practice Dentistry
019016532ILMDDurable Medical Equipment & Medical Supplies

Practice roles

OrganizationSpecialtyStatusNew patients
Dr John F Blattner & Dr. Dwight D Heberer PC General Practice Past Accepting new patients
Dr John F Blattner & Dr Dwight D Heberer PC General Practice PastSince Jan 2, 1980 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511222400000",
    "number": "1720008329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 WESTVIEW PLAZA DR.",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981253",
            "telephone_number": "618-939-4042",
            "fax_number": "618-939-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 WESTVIEW PLAZA DR.",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981253",
            "telephone_number": "618-939-4042",
            "fax_number": "618-939-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLATTNER",
        "first_name": "JOHN",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2017-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19-016532",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "019016532",
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "IL",
            "license": "019016532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IL

Sources for this page

Verify at the official NPI Registry.