Katarzyna Pycinska, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019029355 Issued in IL

Practice address

25158 W Eames St
Channahon, IL 60410-5404

Phone

(815) 467-1111

NPI assigned

Jun 5, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Grand Dental Associates, P.C.

  • General Practice Dentistry
  • Channahon, IL
  • NPI 1598113805
  NPD (past)

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

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371600000000",
    "number": "1164783239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9544 HAWTHORNE DR",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463213420",
            "telephone_number": "219-794-5847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25158 W EAMES ST",
            "city": "CHANNAHON",
            "state": "IL",
            "postal_code": "604105404",
            "telephone_number": "815-467-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PYCINSKA",
        "first_name": "KATARZYNA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-05",
        "last_updated": "2013-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12011797A",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019029355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Pettry-Soto, FNP
• Sheri Pierce, RN
• Anna Piper, NP
• Mackenzie Rue Popko, DMD
• Amy M Pruett, PHARM.D
• Michael Ragan, LPC
• Faiz Rahman, M.D.
• Kimberly Reif, D.T.
• Christopher Reyes
• Rhonda Richter, MA

• Dentist in Channahon, IL
• Providers in Channahon, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2013; 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.