Michele Debra Stark, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

224 E Wall St
Worden, IL 62097-1306

Phone

(618) 459-3626

Fax

(618) 459-7507

NPI assigned

Apr 25, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942429048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 E WALL ST",
            "city": "WORDEN",
            "state": "IL",
            "postal_code": "620971306",
            "telephone_number": "618-459-3626",
            "fax_number": "618-459-7507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 E WALL ST",
            "city": "WORDEN",
            "state": "IL",
            "postal_code": "620971306",
            "telephone_number": "618-459-3626",
            "fax_number": "618-459-7507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "MICHELE",
        "middle_name": "DEBRA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003853",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julia Franz, DC
• Melissa Marie Geninatti, COTA/L
• Randall L Payne
• Christopher Pollock, RN
• Bonnie Katherine Shelton, MSW, LCSW

• General Practice Dentistry in Worden, IL
• Providers in Worden, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.