DR. IVAN GRAHAM DDS - NPI 1669439865 - Dentist in Chicago, IL

Q: What is Ivan Graham's NPI number?

The NPI number for Ivan Graham is 1669439865. It was assigned to this individual provider in the NPPES registry on May 1, 2006.

Q: What is Ivan Graham's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: Is Ivan Graham enrolled in Medicare?

No. Ivan Graham has opted out of Medicare through September 22, 2027. 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.

Q: When was this NPI record last updated?

The NPPES record for Ivan Graham was last updated on October 7, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

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About Dr. Ivan Graham Dds NPPES

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

DR. IVAN GRAHAM DDS (NPI 1669439865) is an individual general practice provider in Chicago, Illinois, licensed in Illinois (019.030195) and active in the NPI registry since May 2006. He has opted out of Medicare through September 22, 2027 and remains eligible to order and refer and maintains a secondary practice location in Orlando.

NPPES Registry Identity

NPI1669439865

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. IVAN GRAHAMCredential: DDS

Location Address5501 S HALSTED STChicago, IL 60621-2229

Mailing Address5501 S Halsted StChicago, IL 60621-2229 · (773) 275-2586

Phone(773) 275-2586

Sole ProprietorNo

Enumeration DateMay 1, 2006

Last NPPES UpdateOctober 7, 20253 updates tracked since enumeration

NPPES CertifiedOctober 7, 2025

✔ NPI 1669439865 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

Licenses✔ Licensed in IL · 019.030195✔ Licensed in FL · DN14742

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

5501 S HALSTED ST, Chicago, IL 60621

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Secondary Practice Location 1

Location 11368 Countryridge PlOrlando, FL 32835-8019 · Phone (407) 385-0301

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. Ivan Graham Dds 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 September 22, 2015 through September 22, 2027.

Opt-Out Effective DateSeptember 22, 2015

Opt-Out In Effect ThroughSeptember 22, 2027Opt-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 60621 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

$94.06 typical visit price

range $60.08 – $183.39

Typical copayment $23.51 (range $15.02 – $45.84)

Most-billed visit code 99203

Established Patient

$74.80 typical visit price

range $18.97 – $148.12

Typical copayment $18.70 (range $4.74 – $37.03)

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 8

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

ZAINAB OTUN RN

Registered Nurse