Active NPI
Jacob Dudzinski, MD
- Dermatology Physician
- Chicago, IL
National Provider Identifier
1033788872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 2021024175
- Practice address
- 1969 W Ogden Ave
Chicago, IL 60612-3765 - Phone
- (312) 864-6000
- NPI assigned
- Jun 24, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 2021024175 | MO | Primary |
Addresses
Primary practice location
1969 W Ogden Ave
Chicago, IL 60612-3765
Mailing address
8931 Ash LN
Hickory Hills, IL 60457-3205
Phone (708) 263-8523
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: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Dermatology
- Education
- Saint Louis University School of Medicine, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292
Hospital & facility affiliations
- John H Stroger Jr Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 11 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 12 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cook County | Single Specialty | Current | Accepting new patients |
| Cook County | Single Specialty | Current | Accepting new patients |
| Cook County | Current | Accepting new patients |
Locations
500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000
1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100
1900 W Polk St
Ste 220C
Chicago, IL 60612
1969 W Ogden Ave
Chicago, IL 60612
Phone (312) 864-3600
Organizations & group practices 3
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.
-
- Multi-Specialty Clinic/Center
- Chicago, IL
- NPI 1831219450
Hospital & facility affiliations 27
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654041600000",
"number": "1033788872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8931 ASH LN",
"city": "HICKORY HILLS",
"state": "IL",
"postal_code": "604573205",
"telephone_number": "708-263-8523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1969 W OGDEN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123765",
"telephone_number": "312-864-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUDZINSKI",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-06-24",
"last_updated": "2022-06-01",
"certification_date": "2022-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": "MO",
"license": "2021024175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.