Scott Christopher Suntrup, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019027276 Issued in IL

Practice address

217 E 2ND St
Flora, IL 62839-2034

Phone

(618) 662-5116

Fax

(618) 403-5996

NPI assigned

Aug 21, 2006

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

Practice roles

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Clay County Health Department

  • Home Health Agency
  • Flora, IL
  • NPI 1083799035

  Operational/Managerial Control

  CMS ownership
• Clay County Health Dept

  • Community Based Hospice Care Agency
  • Flora, IL
  • NPI 1902975188

  Corporate Director

  CMS ownership

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.

• STL Family Dentistry Inc.

  • General Practice Dentistry
  • Saint Louis, MO
  • NPI 1720252398
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1780799361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 E 2ND ST",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628392034",
            "telephone_number": "618-662-5116",
            "fax_number": "618-403-5996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 E 2ND ST",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628392034",
            "telephone_number": "618-662-5116",
            "fax_number": "618-403-5996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNTRUP",
        "first_name": "SCOTT",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Mr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Kent Spicer, B.S.M.S. CCC/SLP-L
• Carrie Dawn Spitzner, LPN
• Springfield Clinic LLP
• Springfield Clinic LLP
• Carmen Stanley, RN
• James R Tarpley
• Henoke Tekeste
• Thrifty Pharmacy
• Throgmorton Powless Pharmacy
• Throgmorton Powless Pharmacy Inc

• General Practice Dentistry in Flora, IL
• Providers in Flora, 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 Jan 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.