Active NPI
Paul F Bery, DDS
- Endodontics
- Evanston, IL
National Provider Identifier
1730225111
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- Practice address
- 636 Church St
Ste#517
Evanston, IL 60201 - Phone
- (847) 475-0120
- Fax
- (847) 475-7883
- NPI assigned
- Jan 30, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | IL | Primary |
Addresses
Primary practice location
636 Church St
Ste#517
Evanston, IL 60201
Mailing address
100 Riverside Dr
Deerfield, IL 60015-4868
Phone (847) 236-1230
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 |
|---|---|---|---|---|
| I20161220000006 | IL | Order and Referring Only - Dentist | 4183905714 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021001269 | IL | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730225111",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 RIVERSIDE DR",
"city": "DEERFIELD",
"state": "IL",
"postal_code": "600154868",
"telephone_number": "847-236-1230",
"fax_number": "847-475-7883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "636 CHURCH ST",
"address_2": "STE#517",
"city": "EVANSTON",
"state": "IL",
"postal_code": "60201",
"telephone_number": "847-475-0120",
"fax_number": "847-475-7883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERY",
"first_name": "PAUL",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evanston, 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.