Marc Rosenthal, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.030533 Issued in IL

Practice address

641 W 63Rd St
Chicago, IL 60621-2032

Phone

(719) 589-5161

NPI assigned

Oct 17, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

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

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.

• Howard Brown Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1306048632
  Medicare reassignment NPD
• Howard Brown Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1255791331
  NPD
• Howard Brown Health Center

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1427523125
  NPD
• Howard Brown Health Center

  • Health Educator
  • Chicago, IL
  • NPI 1811824121
  NPD (past)

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1992794598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "641 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606212032",
            "telephone_number": "719-589-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "641 W 63RD ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606212032",
            "telephone_number": "719-589-5161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "220 S. Worth Street",
            "address_purpose": "LOCATION",
            "city": "Center",
            "state": "CO",
            "postal_code": "81125",
            "country_code": "US",
            "telephone_number": "719-754-3584",
            "fax_number": "719-754-2392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSENTHAL",
        "first_name": "MARC",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-17",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "8416",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.030533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "27839770",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW MEXICO MEDICAID",
            "identifier": "16678028",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019030533",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ROCKY MOUNTAIN HEALTH PLA",
            "identifier": "840706945138",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hallie Rosenthal
• James Rosenthal, MD
• Jason Rosenthal
• Jessica Rosenthal, LCSW
• Kimberly Ann Rosenthal, MD
• Mark Rosenthal
• Michel Rosenthal, LCPC
• Ryan Matthew Rosenthal, D.C.
• Stanley H. Rosenthal, M.D.
• Steve Lee Rosenthal, MHA, BA, CADC, CODP1

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, 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 20, 2022; 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.