Active NPI
Donald Otto Nelson, DDS
- General Practice Dentistry
- Hoffman Estates, IL
National Provider Identifier
1962408401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019013534
- Practice address
- 1475 Glen Lake Rd
Hoffman Estates, IL 60169 - Phone
- (847) 882-2620
- Fax
- (847) 882-0254
- NPI assigned
- Jun 21, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019-013534 | IL | |
| General Practice Dentistry | 1223G0001X | 019013534 | IL | Primary |
Addresses
Primary practice location
1475 Glen Lake Rd
Hoffman Estates, IL 60169
Mailing address
1475 Glen Lake Rd
Hoffman Estates, IL 60169
Phone (847) 882-2620
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150302002484 | IL | Order and Referring Only - Oral Surgery | 2062738479 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-013534 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Webster Dental Care of Hoffman Estates, PC | General Practice | 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.
-
- General Practice Dentistry
- Hoffman Estates, IL
- NPI 1578635637
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540339200000",
"number": "1962408401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1475 GLEN LAKE RD",
"city": "HOFFMAN ESTATES",
"state": "IL",
"postal_code": "60169",
"telephone_number": "847-882-2620",
"fax_number": "847-882-0254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1475 GLEN LAKE RD",
"city": "HOFFMAN ESTATES",
"state": "IL",
"postal_code": "60169",
"telephone_number": "847-882-2620",
"fax_number": "847-882-0254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "DONALD",
"middle_name": "OTTO",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2018-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019-013534",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019013534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Hoffman Estates, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2018; 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.