Loris A Tisocco, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036054667 Issued in IL

Practice address

19 River Oaks Dr
Calumet City, IL 60409

Phone

(708) 862-1290

Fax

(708) 862-6447

NPI assigned

Mar 24, 2006

Last updated

Jan 28, 2020By 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 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ltisocco@directaddress.net

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.

• Pinnacle Dermatology, SC

  • Dermatology Physician
  • Joliet, IL
  • NPI 1861930984

  IN

  Medicare reassignment
• Dermatology and Plastic Surgery Associates, S.C.

  • Procedural Dermatology Physician
  • Joliet, IL
  • NPI 1700987328
  NPD (past)

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580169600000",
    "number": "1205896008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 E BOUGHTON RD",
            "address_2": "STE A",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402565",
            "telephone_number": "815-744-8554",
            "fax_number": "630-495-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 RIVER OAKS DR",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "60409",
            "telephone_number": "708-862-1290",
            "fax_number": "708-862-6447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISOCCO",
        "first_name": "LORIS",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036054667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200015120A",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The University of Chicago Medical Center (UCMC Pharmacy Services)
• The University of Chicago Medical Center (UCMC Pharmacy Services)
• The Womenbrand Inc.
• Skyler Monet Thompson
• Thornton Fractional Township High School District 215
• Total Renal Care Inc (Calumet City)
• Treatment Training Developmental Services, LLC
• Triple K Services LLC
• Kiritkumar D Trivedi, M.D.
• TSN Home Care LLC

• Dermatology Physician in Calumet City, IL
• Providers in Calumet City, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; 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.