Active NPI
John F Blattner, D.M.D
- Customized Equipment (DME)
- Waterloo, IL
National Provider Identifier
1720008329
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Customized Equipment (DME)
- License
- 019016532
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170412000228 | IL | Order and Referring Only - Oral Surgery | 5193041994 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19-016532 | IL | MD | General Practice Dentistry |
| 019016532 | IL | MD | Durable Medical Equipment & Medical Supplies |
Practice roles
| Organization | Specialty | Status | New 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 | Past | 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.
-
- Customized Equipment (DME)
- Waterloo, IL
- NPI 1447400791
General Practice
-
- Customized Equipment (DME)
- Waterloo, IL
- NPI 1215958855
General Practice
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.