Kermit Radke, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

021001688 Issued in IL

Practice address

4165 Old Grand Ave
Gurnee, IL 60031-2774

Phone

(847) 623-4910

Fax

(847) 623-6054

NPI assigned

Jan 15, 2013

Sex

Male

Sole proprietor

Yes

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

Practice roles

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.

• North Suburban Endodontics PC

  • Endodontics
  • Gurnee, IL
  • NPI 1932322021
  NPD (past) Authorized official

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

{
    "created_epoch": "1358208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358208000000",
    "number": "1760729339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4165 OLD GRAND AVE",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312774",
            "telephone_number": "847-623-4910",
            "fax_number": "847-623-6054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4165 OLD GRAND AVE",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600312774",
            "telephone_number": "847-623-4910",
            "fax_number": "847-623-6054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADKE",
        "first_name": "KERMIT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-15",
        "last_updated": "2013-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": "021001688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Jean Purcell, PA-C
• Pure Physical Therapy LLC
• Arthur Warren Purkel Jr., PH.D.
• Vidya Jaganath Puthenveetil, M.D.
• Louise Quist, RN
• Bao-Lan Raikar, MD
• Ralph G Frank DO PC
• Kayla Ramos, MHP
• Chanda L. Ramsey, CRNA
• Ian Roderick Rapisura

• Endodontics in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Endodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; 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.