Timothy Robert Fitzgerald, DDS

Primary specialty

DentistTaxonomy code 122300000X

Practice address

335 W Jackson Street
Macomb, IL 61455-2112

Phone

(309) 833-2125

NPI assigned

Sep 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760580849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 W JACKSON STREET",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614552112",
            "telephone_number": "309-833-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 W JACKSON STREET",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614552112",
            "telephone_number": "309-833-2125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "TIMOTHY",
        "middle_name": "ROBERT",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Practice Associates of Macomb LTD
• Curtis Corman Farr, MD
• Brittany Figge, RD, LDN
• Jordan Fink, P.T.
• Alissa Sue Fisk, LCPC
• Kyle Ford
• Betsy Forrest
• Olivia Franks, M.S., CCC-SLP
• Jacob Frericks, PTA
• Fresenius Medical Care of Illinois, LLC (Fresenius Kidney Care Macomb)

• Dentist in Macomb, IL
• Providers in Macomb, IL by specialty
• Dentist in Illinois

• 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.

Verify at the official NPI Registry.