Theodore James Pawlias, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

019018070 Issued in IL

Practice address

501 East Grant Street
Unit #3
Macomb, IL 61455

Phone

(309) 837-6344

Fax

(309) 837-6344

NPI assigned

Dec 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1232928000000",
    "number": "1831257252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 EAST GRANT STREET",
            "address_2": "UNIT #3",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "61455",
            "telephone_number": "309-837-6344",
            "fax_number": "309-837-6344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 EAST GRANT STREET",
            "address_2": "UNIT #3",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "61455",
            "telephone_number": "309-837-6344",
            "fax_number": "309-837-6344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAWLIAS",
        "first_name": "THEODORE",
        "middle_name": "JAMES",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2009-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019018070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101193",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Damon Lloyd Page, APRN
• Peggy Lou Palmer, COTA/L
• Patricia Lee Pasquesi-Nemec, SLP
• Richard W Passmore, DDS
• Prayag Naineshkumar Patel, MD
• Lindsay J Peachey, N.C.C.
• Dana Peacock
• Pediatric Therapy Services of Macomb, LLC
• Rachel Ellen Pelton
• Michael Patrick Pendergast Sr., ATC

• Dentist in Macomb, IL
• Providers in Macomb, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2009; 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.