Jonathan Bacos, STUDENT

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

B22043894236 Issued in IL

Practice address

240 E Huron St
Suite 1-200
Chicago, IL 60611-2909

Phone

(312) 503-7975

NPI assigned

Aug 17, 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

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585094400000",
    "number": "1265987440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8701 W WATERTOWN PLANK RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532263548",
            "telephone_number": "414-955-4578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 E HURON ST",
            "address_2": "SUITE 1-200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112909",
            "telephone_number": "312-503-7975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACOS",
        "first_name": "JONATHAN",
        "credential": "STUDENT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-17",
        "last_updated": "2020-03-25",
        "certification_date": "2020-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "B22043894236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Backus
• Olga Baclay, PT
• Bethany Bacon, LCSW
• Kathryn S Bacon, RN
• Mary J Bacon, M.A., CCC-SLP
• Nicholas Bacos
• Peter J Bacos, DDS
• Alexandra Baczynski
• Deborah Ann Badagliacco, STA
• Isabella Badalament, DPT

• Student in an Organized Health Care Education/Training Program in Chicago, IL
• Providers in Chicago, IL by specialty
• Student in an Organized Health Care Education/Training Program in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.