DR. ERIC THOMAS SUDHOLT D.M.D.
NPI 1467759944
Dentist in Peoria, IL

Active since February 18, 2011Opted out of Medicare · through Mar 4, 2028
838 W GLEN AVE, PEORIA, IL 61614(309) 691-1990 Get Directions Write a Review

NPPES record last updated: February 18, 2011. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Eric Thomas Sudholt D.m.d. NPPES

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

DR. ERIC THOMAS SUDHOLT D.M.D. (NPI 1467759944) is an individual dentist in Peoria, Illinois, licensed in Illinois (019028324) and active in the NPI registry since February 2011. He has opted out of Medicare through March 4, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1467759944
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameDR. ERIC THOMAS SUDHOLTCredential: D.M.D.
Location Address838 W GLEN AVEPeoria, IL 61614-4835
Mailing Address838 W Glen AvePeoria, IL 61614-4835 · (309) 691-1990
Sole ProprietorNo
Enumeration DateFebruary 18, 2011
NPI 1467759944 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License Licensed in IL · 019028324
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.

838 W GLEN AVE, Peoria, IL 61614

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Dr. Eric Thomas Sudholt D.m.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from March 4, 2016 through March 4, 2028.

Opt-Out Effective DateMarch 4, 2016
Opt-Out In Effect ThroughMarch 4, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61614 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.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Dentist (General Practice)
838 W GLEN AVE
PEORIA, IL 61614
Dentist (General Practice)
838 W GLEN AVE
PEORIA, IL 61614
Dentist (General Practice)
838 W GLEN AVE
PEORIA, IL 61614
Dentist (General Practice)
838 W GLEN AVE
PEORIA, IL 61614
Dentist (General Practice)
838 W GLEN AVE
PEORIA, IL 61614

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 Eric Sudholt's NPI number?

The NPI number for Eric Sudholt is 1467759944. It was assigned to this individual provider in the NPPES registry on February 18, 2011.

Where is Eric Sudholt located?

Eric Sudholt practices at 838 W Glen Ave, Peoria, IL 61614. The listed phone number is (309) 691-1990.

What is Eric Sudholt's specialty?

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

Is Eric Sudholt enrolled in Medicare?

No. Eric Sudholt has opted out of Medicare through March 4, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Eric Sudholt was last updated on February 18, 2011. NPI Profile syncs with the weekly NPPES data releases published by CMS.