Active NPI
Thomas Endicott, D.D.S.
- Dentist
- Chicago, IL
National Provider Identifier
1124261623
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Sep 19, 2024.
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019025785
- Practice address
- 430 W Erie St
Ste 200
Chicago, IL 60654-6914 - Phone
- (602) 295-4040
- NPI assigned
- Apr 13, 2009
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019025785 | IL | Primary |
Addresses
Primary practice location
430 W Erie St
Ste 200
Chicago, IL 60654-6914
Mailing address
430 W Erie St
Ste 200
Chicago, IL 60654-6914
Phone (602) 295-4040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019025785 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239580800000",
"number": "1124261623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 W ERIE ST",
"address_2": "STE 200",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606546914",
"telephone_number": "602-295-4040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 W ERIE ST",
"address_2": "STE 200",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606546914",
"telephone_number": "602-295-4040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ENDICOTT",
"first_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-13",
"last_updated": "2009-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019025785",
"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 Apr 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.