NPIMap

Organization Active NPI

Southern Illinois University Carbondale

Doing business as Community Dental Center

  • Dental Clinic/Center
  • Carbondale, IL
National Provider Identifier
1962674788
Registry record updated Sep 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
019024395 Issued in IL
Legal business name
SOUTHERN ILLINOIS UNIVERSITY CARBONDALE
Doing business as
Community Dental Center
Practice address
1365 Douglas Drive
Carbondale, IL 62901
Phone
(618) 453-2353
NPI assigned
Apr 1, 2008
Last updated
Sep 24, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHERN ILLINOIS UNIVERSITY CARBONDALEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 24, 2021

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

Authorized official

Name
Lauren Cripps, DMDNPI 1780035451
Title
Dentist
Phone
(618) 453-2353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019024395 IL Primary

Addresses

Primary practice location

1365 Douglas Drive
Carbondale, IL 62901

Mailing address

1365 Douglas Drive
Carbondale, IL 62901
Phone (618) 453-2353

Other identifiers 4

IdentifierTypeStateIssuer
1023008364MedicaidIL
1184615866MedicaidIL
019.032439MedicaidIL
1295716959MedicaidIL

Other names 1

  • Community Dental Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Susan M Tucker MD29 organizations share this tax ID, including this one
Part of
Susan M Tucker MD

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632441600000",
    "number": "1962674788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365 DOUGLAS DRIVE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "62901",
            "telephone_number": "618-453-2353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 DOUGLAS DRIVE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "62901",
            "telephone_number": "618-453-2353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS UNIVERSITY CARBONDALE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN ILLINOIS UNIVERSITY CARBONDALE",
        "enumeration_date": "2008-04-01",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A",
        "authorized_official_last_name": "CRIPPS",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "618-453-2353",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019024395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023008364",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184615866",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019.032439",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295716959",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.