Active NPI
Ivo Komornicki
- Dentist
- Champaign, IL
National Provider Identifier
1821962119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.036319
- Practice address
- 805 W Springfield Ave
Champaign, IL 61820 - Phone
- (217) 352-5088
- NPI assigned
- Oct 1, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.036319 | IL | Primary |
Addresses
Primary practice location
805 W Springfield Ave
Champaign, IL 61820
Mailing address
805 W Springfield Ave.
Champaign, IL 61820
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.036319 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1759276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759276800000",
"number": "1821962119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "805 W SPRINGFIELD AVE.",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "61820"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "805 W SPRINGFIELD AVE",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "61820",
"telephone_number": "217-352-5088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOMORNICKI",
"first_name": "IVO",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2025-10-01",
"last_updated": "2025-10-01",
"certification_date": "2025-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.036319",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.