Scott P. Fogel DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019026391 Issued in IL

Legal business name

SCOTT P. FOGEL DDS PC

Practice address

1521 N Convent St
Suite 600
Bourbonnais, IL 60914-1468

Phone

(815) 933-5173

Fax

(815) 933-5191

NPI assigned

Aug 17, 2006

Organization subpart

Yes

Parent organization

SCOTT P. FOGEL DDS PCAs reported in NPPES

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

Authorized official

Name

Dr. Scott P. Fogel, DDSNPI 1679818835

Title

Owner

Phone

(815) 933-5173

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 18, 2015 through Oct 18, 2027

Medicare enrollment (NPD)

Not enrolled

Part of

Scott P Fogel DDS PC

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Scott Paul Fogel, DDS

  • Dentist
  • Bourbonnais, IL
  • NPI 1679818835
  NPD (past) Authorized official

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353888000000",
    "number": "1750494142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1521 N CONVENT ST",
            "address_2": "SUITE 600",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141468",
            "telephone_number": "815-933-5173",
            "fax_number": "815-933-5191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 N CONVENT ST",
            "address_2": "SUITE 600",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141468",
            "telephone_number": "815-933-5173",
            "fax_number": "815-933-5191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT P. FOGEL DDS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SCOTT P. FOGEL DDS PC",
        "enumeration_date": "2006-08-17",
        "last_updated": "2012-11-26",
        "status": "A",
        "authorized_official_last_name": "FOGEL",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-933-5173",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Marie Schuldt
• Deanna Schultz, RBT-18-58645
• Timothy J Schultz
• Chelsea Marie Schwarzkopf
• Mary Schweigert, NP-C
• Emily Rachel Segal, ATR, LCPC
• David Sell
• Seretis Dental LLC
• Michael John Sergeant Sr., M.D.
• Jason L Serpe, DPM

• General Practice Dentistry in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.