POONAM JAIN – General Practice Dentistry, NPI 1790799385
General Practice Dentistry
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for POONAM JAIN
109 W MAIN ST
STAUNTON, IL 620881452
Phone: (618) 635-2280
Fax: (618) 635-2902
Type: Location
24, Ginger Creek Parkway, Glen Hills, Glen Carbon, Madison County, Illinois, 62034, United States
GLEN CARBON, IL 620343502
Phone: (618) 692-1110
Fax: (618) 692-1112
Type: Location
5, Evergreen Drive, Staunton, Macoupin County, Illinois, 62088, United States
STAUNTON, IL 620882217
Phone: (618) 978-1847
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $2,642.
Total Amount is formed as General ($2,642) + Research ($0) + Ownership ($0) = $2,642.
Last reported payment date: 2024-12-11 • Largest payer in this snapshot: GC America Inc. ($2,500).
Total Amount
$2,642
General + Research + Ownership
Payments
3
Total payment records
General Amount
$2,642
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| GC America Inc. | $2,500 |
| Peter Brasseler Holdings, LLC | $121 |
| PATTERSON COMPANIES, INC. | $21 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20250108000994 | O | Oral Surgery - Dentist | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 62088)
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Reviews
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