Individual provider Active NPI

Payam Rezai, D.D.S.

  • Dentist
  • Chicago, IL
National Provider Identifier
1770804411
Registry record updated Sep 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019028289 Issued in IL
Practice address
3927 W Belmont Ave Ste 105
Chicago, IL 60618-5170
Phone
(847) 502-2127
NPI assigned
Jun 17, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019028289 IL Primary

Addresses

Primary practice location

3927 W Belmont Ave Ste 105
Chicago, IL 60618-5170

Mailing address

1901 S Calumet Ave Unit 1107
Chicago, IL 60616-6008
Phone (847) 502-2127

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151222002396 IL Order and Referring Only - DentistPractitioner - Dentist 1557662236

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019028289ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Payam Rezai DDS PC Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1276732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379894400000",
    "number": "1770804411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 S CALUMET AVE UNIT 1107",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606166008",
            "telephone_number": "847-502-2127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3927 W BELMONT AVE STE 105",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606185170",
            "telephone_number": "847-502-2127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZAI",
        "first_name": "PAYAM",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-17",
        "last_updated": "2013-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.