Active NPI
Jack Dustin, MD
- Family Medicine Physician
- Deerfield, IL
National Provider Identifier
1184996472
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 336.023475
- Practice address
- 540 Lake Cook Rd
Deerfield, IL 60015-5289 - Phone
- (847) 564-8500
- NPI assigned
- Feb 1, 2012
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 336.023475 | IL | Primary |
Addresses
Primary practice location
540 Lake Cook Rd
Deerfield, IL 60015-5289
Mailing address
404 E Parkview CT
Arlington HTS, IL 60005-3846
Phone (847) 364-5531
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 336.023475 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328054400000",
"number": "1184996472",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 E PARKVIEW CT",
"city": "ARLINGTON HTS",
"state": "IL",
"postal_code": "600053846",
"telephone_number": "847-364-5531",
"fax_number": "847-364-4610"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 LAKE COOK RD",
"city": "DEERFIELD",
"state": "IL",
"postal_code": "600155289",
"telephone_number": "847-564-8500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUSTIN",
"first_name": "JACK",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-01",
"last_updated": "2012-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "336.023475",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Deerfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.