Adam John McKissock, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

9878 Issued in CO

Practice address

1720 Jet Stream Dr Ste 110
Colorado Springs, CO 80921-3938

Phone

(719) 488-2188

Fax

(719) 488-2188

NPI assigned

May 4, 2006

Last updated

May 16, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Dr. John McKissock Professional name

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elevation Endodontics, PLLC

  dba Elevation Endodontics

  • Dental Clinic/Center
  • Colorado Springs, CO
  • NPI 1144095381
  NPD Authorized official
• JJ Elevation, PLLC

  dba Elevation Endodontics

  • Endodontics
  • Colorado Springs, CO
  • NPI 1447803382
  NPD Authorized official
• Transtrum Endodontics PLLC

  dba Aspen Endodontics

  • Endodontics
  • Colorado Springs, CO
  • NPI 1871035212
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1073561213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 JET STREAM DR STE 110",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809213938",
            "telephone_number": "719-488-2188",
            "fax_number": "719-488-2188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 JET STREAM DR STE 110",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809213938",
            "telephone_number": "719-488-2188",
            "fax_number": "719-488-2188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKISSOCK",
        "first_name": "ADAM",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "DN 16025",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "CO",
            "license": "9878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "MCKISSOCK",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Najea McKinney
• Nicole McKinney, MD
• Brian McKinnon, LPN
• Michael Sean McKisic, MD
• Christy McKissick, RBT
• Tami M McKittrick, BCBA
• Chad E McKnight, LCSW
• Graeme McKnight, ADDC, LPCC
• Camille McKrola
• Jade McLachlin, OD

• Endodontics in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Endodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.