Tommy John Castillo Sagadraca, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.030727 Issued in IL

Practice address

1564 W Lane Rd
Machesney Park, IL 61115-1903

Phone

(779) 771-6763

NPI assigned

Jun 21, 2016

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

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

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

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466467200000",
    "number": "1215387113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 ENGLISH OAK LN",
            "city": "STREAMWOOD",
            "state": "IL",
            "postal_code": "601073392",
            "telephone_number": "630-664-9298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1564 W LANE RD",
            "city": "MACHESNEY PARK",
            "state": "IL",
            "postal_code": "611151903",
            "telephone_number": "779-771-6763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAGADRACA",
        "first_name": "TOMMY JOHN",
        "middle_name": "CASTILLO",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-21",
        "last_updated": "2016-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.030727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Veronica L Roberts, O.D.
• Helen Rodriguez
• Michael O Romuar
• Vicki Lynn Rudh Jones, P.T.
• Noel Elizabeth Ryall
• Saint Anthony Medical Center
• Sunitha Ann Samuel, DDS
• Ricardo Alejandro Sanabria
• Amanda Jean Satterlee, MS, LCPC, NCC
• Lisa A Schuld, PT

• General Practice Dentistry in Machesney Park, IL
• Providers in Machesney Park, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; 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.