Benjamin Jacob Schlott, D.M.D , M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

021002736 Issued in IL

Practice address

3555 College Ave
Alton, IL 62002-5009

Phone

(618) 462-1646

Fax

(618) 462-5211

NPI assigned

Apr 14, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 7

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL, IL2 enrollments

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 2

Specialty

Oral Surgery

Education

Southern Illinois Univ School of Dental Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Bi-State Oral and Facial Surgery, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Alton, IL
  • NPI 1669824439
  Medicare reassignment NPD Authorized official
• Faculty Associates Incorporated

  • Dentist
  • Gainesville, FL
  • NPI 1255383550
  Medicare reassignment NPD
• Crammond & Helden LTD

  • Oral and Maxillofacial Surgery (Dentist)
  • Alton, IL
  • NPI 1538295522
  NPD (past)

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

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1891938296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 COLLEGE AVE",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620025009",
            "telephone_number": "618-462-1646",
            "fax_number": "618-462-5211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 COLLEGE AVE",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620025009",
            "telephone_number": "618-462-1646",
            "fax_number": "618-462-5211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHLOTT",
        "first_name": "BENJAMIN",
        "middle_name": "JACOB",
        "name_prefix": "Dr.",
        "credential": "D.M.D , M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-14",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019026421",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MO",
            "license": "2011013340",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DTP602",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DTP602",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MO",
            "license": "2011022969",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "IL",
            "license": "036140395",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "021002736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891938296",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Alton Memorial Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1 Memorial Dr",
            "city": "Alton",
            "state": "IL",
            "country_code": "US",
            "postal_code": "620026722",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Schafer, P.T.
• Christina Schaljo, P.T.
• Danielle Scheibal, MC
• Justin Scheiter, O.D.
• Mary L Schinkel, D.O.
• Stephanie Schmidt, BA
• Thomas Schmidt
• Matthew Schneider
• Katelyn Schneidewind
• David Michael Schottel

• Oral and Maxillofacial Surgery (Dentist) in Alton, IL
• Providers in Alton, 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 Dec 2, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.