Susan Patel, DDS

Primary specialty

DentistTaxonomy code 122300000X

Practice address

761 Main St NW
Ste C
Bourbonnais, IL 60914-2333

Phone

(815) 933-3377

Fax

(815) 933-6530

NPI assigned

Mar 13, 2007

Sex

Female

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

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.

• Lifetime Dental Care of Illinois, PC

  • General Practice Dentistry
  • Bourbonnais, IL
  • NPI 1770705923
  NPD (past)

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780717363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "761 MAIN ST NW",
            "address_2": "STE C",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142333",
            "telephone_number": "815-933-3377",
            "fax_number": "815-933-6530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "761 MAIN ST NW",
            "address_2": "STE C",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142333",
            "telephone_number": "815-933-3377",
            "fax_number": "815-933-6530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "SUSAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J Michael Panuska, MD, MPH
• Azra N Pappa, DO
• Dhaval Patel, D.O.
• Pathik K Patel, DMD
• Shefali Patel, MPT
• Tayler Peachey, O.D.
• Derek Pequette, PT
• Eric Perez
• Heather Elizabeth Perez, PSY.D.
• Virginia Perez, LCSW, LICSW

• Dentist in Bourbonnais, IL
• Providers in Bourbonnais, 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.