Individual provider Active NPI

Manal Yasin, D.D.S.

  • Dentist
  • Chicago, IL
National Provider Identifier
1811320799
Registry record updated Dec 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019030479 Issued in IL
Practice address
5425 W Lake St
Chicago, IL 60644-2342
Phone
(773) 378-3347
Fax
(773) 378-4028
NPI assigned
Aug 15, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 27, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS039944 PA
Dentist 122300000X 019030479 IL Primary

Addresses

Primary practice location

5425 W Lake St
Chicago, IL 60644-2342

Mailing address

107 Saint Tropez Cir
Beaver Falls, PA 15010-3174

Other practice location 1

7372 McKnight Rd Ste B
Pittsburgh, PA 15237-3558
Phone (412) 837-3026

Other practice location 2

6201 Roosevelt Rd
Berwyn, IL 60402-1108
Phone (708) 386-0845

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
I20160427002248 IL Practitioner - DentistPractitioner - Oral Surgery 7810296738 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019030479ILMDDentist
DS039944PAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Erie Family Health Center Inc CurrentSince Apr 4, 2016 Accepting new patients
PCC Community Wellness Center CurrentSince Aug 31, 2017 Accepting new patients
Erie Family Health Center, Inc Current Accepting new patients
Erie Family Health Center Inc CurrentSince Apr 4, 2016 Accepting new patients
PCC Community Wellness Center CurrentSince Aug 31, 2017 Accepting new patients

Locations

6201 Roosevelt Rd
Berwyn, IL 60402
Phone (708) 386-0845

5425 W Lake St
Chicago, IL 60644
Phone (773) 378-3347

1504 S Albany Ave
Chicago, IL 60623

1701 W Superior St
Fl 3
Chicago, IL 60622
Phone (312) 432-7381

1285 Hartrey Ave
Evanston, IL 60202
Phone (847) 666-2302

14 Lake St
Oak Park, IL 60302
Phone (708) 383-0113

Interoperability endpoints

  • Direct secure messaging: manal.yasin.1@13158.direct.athenahealth.com

Organizations & group practices 5

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": "1376524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577404800000",
    "number": "1811320799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 SAINT TROPEZ CIR",
            "city": "BEAVER FALLS",
            "state": "PA",
            "postal_code": "150103174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5425 W LAKE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606442342",
            "telephone_number": "773-378-3347",
            "fax_number": "773-378-4028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7372 McKnight Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152373558",
            "country_code": "US",
            "telephone_number": "412-837-3026",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6201 Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Berwyn",
            "state": "IL",
            "postal_code": "604021108",
            "country_code": "US",
            "telephone_number": "708-386-0845",
            "fax_number": "708-386-8472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YASIN",
        "first_name": "MANAL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-15",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039944",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019030479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.