Philip R Banghart, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

019-021176 Issued in IL

Practice address

102 Professional PLZ
Mattoon, IL 61938-9252

Phone

(217) 345-7070

Fax

(217) 345-7077

NPI assigned

Jun 15, 2005

Sex

Male

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial Surgery

Education

Univ of Illinois at Chicago College of Dentistry, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Affiliates in Oral and Maxillofacial Surgery LTDGroup PAC ID 0345309779, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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.

• Affiliates in Oral & Maxillofacial Surgery LTD

  • Oral and Maxillofacial Surgery (Dentist)
  • Champaign, IL
  • NPI 1215196290
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226275200000",
    "number": "1982609087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 PROFESSIONAL PLZ",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389252",
            "telephone_number": "217-345-7070",
            "fax_number": "217-345-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 PROFESSIONAL PLZ",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389252",
            "telephone_number": "217-345-7070",
            "fax_number": "217-345-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANGHART",
        "first_name": "PHILIP",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2008-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "019-021176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019-021176",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Ayonote, M.D.
• Angela Azor
• Emily Nicole Baker, BS
• Kaitlyn Baker, BS
• Lisa R. Ballinger, M.A., LCPC
• Christine M Banks, APRN
• Sophie Barenie, MA CC-SLP
• Sarah Grace Baron
• Loring Barr, APRN
• Brett Bartlett, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Mattoon, IL
• Providers in Mattoon, 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 Nov 10, 2008; 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.