Frederick Gustave, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

021001098 Issued in IL

Practice address

10200 W Main St
Belleville, IL 62223-1408

Phone

(618) 400-6725

Fax

(618) 500-6725

NPI assigned

Jul 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2021 through Jul 1, 2027

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• Oral Facial Surgery Institute of Illinois P C

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Belleville, IL
  • NPI 1740697333

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1891709168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10200 W MAIN ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622231408",
            "telephone_number": "618-400-6725",
            "fax_number": "618-500-6725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10200 W MAIN ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622231408",
            "telephone_number": "618-400-6725",
            "fax_number": "618-500-6725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAVE",
        "first_name": "FREDERICK",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-29",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019016600",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021001098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Jacqueline Grumbine, LAC
• Courtney M Guebert, PA-C
• Michael Gerard Guignon Sr., MD
• Lauren Gunter, LCSW
• Adam Joseph Guss
• Corrina M Guthrie, PTA, ATC
• Virgilio T Guzman, MD
• Gwinn Chiropractic Center
• Megan Renee Gwinn, D.C.
• Dolph D Haege, MD

• Oral and Maxillofacial Surgery (Dentist) in Belleville, IL
• Providers in Belleville, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.