Individual provider Active NPI

Penny Ann Belke, D.D.S.

  • General Practice Dentistry
  • Glen Ellyn, IL
National Provider Identifier
1891866927
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
45 S Park Blvd
Suite 224
Glen Ellyn, IL 60137-6280
Phone
(630) 942-0323
Fax
(630) 942-0467
NPI assigned
Nov 12, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X IL Primary

Addresses

Primary practice location

45 S Park Blvd
Suite 224
Glen Ellyn, IL 60137-6280

Mailing address

45 S Park Blvd
Suite 224
Glen Ellyn, IL 60137-6280
Phone (630) 942-0323

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
I20150706001009 IL Order and Referring Only - DentistPractitioner - Dentist 4587976592

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1163289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891866927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 S PARK BLVD",
            "address_2": "SUITE 224",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376280",
            "telephone_number": "630-942-0323",
            "fax_number": "630-942-0467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 S PARK BLVD",
            "address_2": "SUITE 224",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376280",
            "telephone_number": "630-942-0323",
            "fax_number": "630-942-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELKE",
        "first_name": "PENNY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Ellyn, IL

Sources for this page

Verify at the official NPI Registry.