1. Home
  2. Directory
  3. Illinois
  4. East Peoria
  5. Dentist
  6. NPI Profile

DR. JACK GLENN WALZ DDS
NPI 1427166008
Dentist in East Peoria, IL

Active since August 25, 2006PECOS Enrolled
731 SABRINA DRIVE, STE A, EAST PEORIA, IL 61611(309) 699-1300(309) 699-5399 Get Directions Write a Review

NPPES record last updated: March 12, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Jack Glenn Walz Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACK GLENN WALZ DDS (NPI 1427166008) is an individual dentist in East Peoria, Illinois, licensed in Illinois (019021995) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS and is a graduate of Other (1981).

NPPES Registry Identity

NPI1427166008
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameDR. JACK GLENN WALZCredential: DDS
Location Address731 SABRINA DRIVE, STE AEast Peoria, IL 61611
Mailing Address731 Sabrina Dr, Unit AEast Peoria, IL 61611-3582 · (309) 699-1300 · Fax (309) 699-5399
Phone(309) 699-1300
Fax(309) 699-5399
Sole ProprietorNo
Medical School CMSOtherGraduated 1981
Enumeration DateAugust 25, 2006
Last NPPES UpdateMarch 12, 2018
✔ NPI 1427166008 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in IL · 019021995
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
731 SABRINA DRIVE, East Peoria, IL 61611
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jack Glenn Walz Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3971784901
PECOS Enrollment IDI20130617000060
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jack Walz reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Central Illinois Center For Tmj And Facial Pain PC
0.8 mi
Dentist
731 SABRINA DR, SUITE A
East Peoria, IL 61611
  • Reassigned Medicare billing, Illinois enrollment
NPI 1962745232 (309) 699-1300

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
189 services153 patients
New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
65 services65 patients
X-ray of body plane 76100
An X-ray of a body plane is a non-invasive imaging test that helps visualize the inside of your body. It uses a small amount of radiation to produce images of structures within your body, such as bones and organs. This procedure aids in diagnosing, monitoring, and treating various medical conditions.
60 services18 patients
X-ray of lower jaws, upper jaws and teeth 70355
An X-ray of lower jaws, upper jaws, and teeth is a diagnostic procedure that uses radiation to create images of these areas. This helps in identifying issues like tooth decay, gum problems, or jawbone irregularities. It's a quick, painless process and crucial for maintaining oral health.
48 services48 patients
X-ray of skull, 1-3 views 70250
An X-ray of the skull involves capturing images of the bones and tissues in your head. This test helps identify issues like fractures, infections, or tumors. The '1-3 views' means pictures will be taken from one to three different angles for a comprehensive assessment.
16 services16 patients
Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
16 services16 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61611 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$68.64 typical visit price
range $17.16 – $136.56
Typical copayment $17.16 (range $4.29 – $34.14)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Walz's NPI number?

The NPI number for Jack Walz is 1427166008. It was assigned to this individual provider in the NPPES registry on August 25, 2006.

Where is Jack Walz located?

Jack Walz practices at 731 Sabrina Drive Ste A, East Peoria, IL 61611. The listed phone number is (309) 699-1300.

What is Jack Walz's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Is Jack Walz enrolled in Medicare?

Yes. Jack Walz is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Jack Walz's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Walz reassigns Medicare benefits to Central Illinois Center For Tmj And Facial Pain PC (East Peoria, IL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jack Walz's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jack Walz was last updated on March 12, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.