Individual provider Active NPI

Erik Vineyard Taube, DMD

  • Dentist
  • Mascoutah, IL
National Provider Identifier
1891043451
Registry record updated Aug 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
019.029166 Issued in IL
Practice address
104 E Main St
Mascoutah, IL 62258-2135
Phone
(618) 566-7384
NPI assigned
Aug 29, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 019.029166 IL Primary

Addresses

Primary practice location

104 E Main St
Mascoutah, IL 62258-2135

Mailing address

104 E Main St
Mascoutah, IL 62258-2135
Phone (618) 566-7384

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
I20160609000649 IL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6204126816

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019.029166ILMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Taube Family Dental Dentist Past Accepting new patients

Organizations & group practices 1

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": "1346198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346198400000",
    "number": "1891043451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 E MAIN ST",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622582135",
            "telephone_number": "618-566-7384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 E MAIN ST",
            "city": "MASCOUTAH",
            "state": "IL",
            "postal_code": "622582135",
            "telephone_number": "618-566-7384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAUBE",
        "first_name": "ERIK",
        "middle_name": "VINEYARD",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-29",
        "last_updated": "2012-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.029166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mascoutah, IL

Sources for this page

Verify at the official NPI Registry.