Individual provider Active NPI

Heidi A Novack, D.D.S.

  • General Practice Dentistry
  • Countryside, IL
National Provider Identifier
1992816557
Registry record updated Jan 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
6686 Joliet Rd
Countryside, IL 60525-4575
Phone
(708) 784-0400
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X IL Primary

Addresses

Primary practice location

6686 Joliet Rd
Countryside, IL 60525-4575

Mailing address

9S221 Graceland St
Downers Grove, IL 60516-5029
Phone (630) 910-8890

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231019003291 IL Practitioner - Dentist 5890015259 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019018051ILMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Aria Dental Care PC CurrentSince Aug 21, 2023 Accepting new patients

Locations

901 S 2nd St
Ste 201
Springfield, IL 62704
Phone (312) 560-2917

8500 W 110th St
Ste 450
Overland Park, KS 66210
Phone (913) 362-1112

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200009600000",
    "number": "1992816557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9S221 GRACELAND ST",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605165029",
            "telephone_number": "630-910-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6686 JOLIET RD",
            "city": "COUNTRYSIDE",
            "state": "IL",
            "postal_code": "605254575",
            "telephone_number": "708-784-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOVACK",
        "first_name": "HEIDI",
        "middle_name": "A",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Countryside, IL

Sources for this page

Verify at the official NPI Registry.