DRS DORAN CAPODICE EFAW & OCHELTREE LLC (NPI# 1710985759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710985759 |
| Entity Type | Organization |
| Organization Name | DRS DORAN CAPODICE EFAW & OCHELTREE LLC |
| Practice Address |
109 N Regency Dr Bloomington IL 61701-3515 |
| Practice Telephone | 3096632526 |
| Practice Fax Number | 3096634788 |
| Mailing Telephone | 3096632526 |
| Mailing Fax Number | 3096634788 |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2017-11-16 |
| Authorized Official Name | DR. STEPHEN N DORAN (SURGEON) |
| Authorized Official Telephone | 3096632526 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | Y |
| Parent Organization Name | DRS DORAN CAPODICE EFAW & OCHELTREE LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers | ||
| N | 204E00000X | Oral & Maxillofacial Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 174400000X | Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 019018830 | 05 | |
| IL | 019023548 | 05 | |
| IL | 019022744 | 05 |
| Street Address |
109 N REGENCY DR |
| City | BLOOMINGTON |
| State | IL |
| Zip Code | 61701-3515 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114363579 | Anthony Mitchell Elger | Dentist | 109 N Regency Dr, Bloomington, IL 61701-3515 | 2013-05-13 |
| 1205892973 | Thomas Charles Ocheltree Jr. | Dentist | 109 N Regency Dr, Bloomington, IL 61701-3515 | 2006-04-21 |
| 1700862877 | David Efaw | Dentist | 109 N Regency Dr, Bloomington, IL 61701-3515 | 2005-12-20 |
| 1376529750 | Stephen N Doran | Dentist | 109 N Regency Dr, Bloomington, IL 61701-3515 | 2005-12-19 |
| 1053397612 | Jack Capodice Jr. | Dentist | 109 N Regency Dr, Bloomington, IL 61701-3515 | 2005-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770140964 | County of Mclean | Community/Behavioral Health | 200 W Front St, 1st Floor Sw, C/o 200 W Front St, Suite 400f, Bloomington, IL 61701 | 2019-05-22 |
| 1023525292 | Karli Johnson | Counselor | 200 W Monroe St Ste C7, Bloomington, IL 61701 | 2018-01-09 |
| 1487172409 | Melody Ann Bauman | Physician Assistant | 1505 Eastland Dr, Osf Critical Cane, Pulmonary, Sleep M, Bloomington, IL 61701 | 2017-08-30 |
| 1215396288 | Heidi Larsen | Social Worker | 902 S East St, Bloomington, IL 61701 | 2016-02-18 |
| 1558735126 | Andrea E. Andrews Counseling LLC | Counselor | 200 W. Monroe St., Ste 302 C, Bloomington, IL 61701 | 2015-11-19 |
| 1174924856 | Carole Hahn | Dietitian, Registered | 1406 Forrest St, Bloomington, IL 61701 | 2014-09-12 |
| 1558786392 | Valerie Colleen Parker | Counselor | 109 W. Mulberry St., Bloomington, IL 61701 | 2014-03-04 |
| 1124459219 | Matilde Francois | Surgery | 1505 Eastland Dr Ste 2300, Bloomington, IL 61701 | 2013-11-27 |
| 1922435114 | Smitha H Shivaprasad | Pharmacist | 2611 East Oakland Avenue, Bloomington, IL 61701 | 2013-10-02 |
| 1295161941 | Ashvin Patel | Obstetrics & Gynecology | 31 Country Club Pl, Bloomington, IL 61701 | 2013-09-25 |
| Find all providers in zip 61701 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578931796 | Gailey Westlund | Specialist | 2120 W Old Shakopee Rd # 3, Bloomington, MN 55431-3000 | 2015-09-03 |
| 1063719169 | Robert A Spicer | Specialist | 5225 W Vernal Pike, Bloomington, IN 47404-9661 | 2011-02-25 |
| 1073815882 | Stephen G Moore | Specialist | 2749 E Covenanter Dr, Bloomington, IN 47401-5454 | 2010-11-30 |
| 1508172099 | Annabelle L Ogerio | Specialist | 1211 Broad Creek Rd, Bloomington, IL 61704-8536 | 2010-08-23 |
| 1366684086 | Sterling Jerel Shores | Specialist | 2301 Ge Rd Apt 12, Bloomington, IL 61704-3425 | 2009-03-26 |
| 1205083417 | Anne J Ford Msw Licsw LLC | Specialist | 9810 Edgewood Rd, Bloomington, MN 55438-1755 | 2008-08-20 |
| 1700066008 | Kab Medical Associates, Inc | Specialist | 2998 S Sare Rd, Bloomington, IN 47401-4330 | 2007-11-05 |
| 1164557799 | Biofeedback Training and Treatment Center, Inc. | Specialist | 5001 American Blvd W Ste 980, Biofeedback Training & Treatment Center, Inc., Bloomington, MN 55437-1164 | 2007-02-22 |
| 1093877151 | Alan B Somers | Specialist | 3800 Commodore Trl, Bloomington, IN 47408-9423 | 2006-12-15 |
| 1174692115 | Taehwan Kim | Specialist | 5342 Paola Cir, Bloomington, MN 55437-1052 | 2006-11-06 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 61701 |
Please comment or provide details below to improve the information on DRS DORAN CAPODICE EFAW & OCHELTREE LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.