Active NPI
Jason L Stanczyk, D.M.D., M.S.
- Periodontics
- Swansea, IL
National Provider Identifier
1013127752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- Practice address
- 11 Park PL
Swansea, IL 62226-2925 - Phone
- (618) 233-7300
- Fax
- (618) 233-7432
- NPI assigned
- May 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | IL | Primary |
Addresses
Primary practice location
11 Park PL
Swansea, IL 62226-2925
Mailing address
11 Park PL
Swansea, IL 62226-2925
Phone (618) 233-7300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150406000082 | IL | Order and Referring Only - Other (Physician) | 1052639960 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021002125 | IL | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Periodontics of Southern Illinois | Periodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Periodontics
- Belleville, IL
- NPI 1639224876
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013127752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 PARK PL",
"city": "SWANSEA",
"state": "IL",
"postal_code": "622262925",
"telephone_number": "618-233-7300",
"fax_number": "618-233-7432"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 PARK PL",
"city": "SWANSEA",
"state": "IL",
"postal_code": "622262925",
"telephone_number": "618-233-7300",
"fax_number": "618-233-7432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STANCZYK",
"first_name": "JASON",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "D.M.D., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Swansea, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.