Active NPI
Ketan S Bedmutha, DMD
- General Practice Dentistry
- Chicago, IL
National Provider Identifier
1851896286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019.032066
- Practice address
- 1950 W Cermak Rd
Chicago, IL 60608-4204 - Phone
- (773) 376-2777
- NPI assigned
- Mar 27, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019.032066 | IL | Primary |
Addresses
Primary practice location
1950 W Cermak Rd
Chicago, IL 60608-4204
Mailing address
601 W Jackson Blvd Unit 1404
Chicago, IL 60661-5642
Phone (716) 725-1593
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190416001102 | NY | Order and Referring Only - Dentist | 8820339047 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.032066 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619222400000",
"number": "1851896286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 W JACKSON BLVD UNIT 1404",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606615642",
"telephone_number": "716-725-1593"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1950 W CERMAK RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606084204",
"telephone_number": "773-376-2777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEDMUTHA",
"first_name": "KETAN",
"middle_name": "S",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-27",
"last_updated": "2021-04-24",
"certification_date": "2021-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019.032066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2021; 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.