NPIMap

Organization Active NPI

Evaskus and Herzog, LTD

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Chicago, IL
National Provider Identifier
1316044837
Registry record updated Dec 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
Legal business name
EVASKUS AND HERZOG, LTD
Practice address
2440 W Peterson Ave
Chicago, IL 60659-4113
Phone
(773) 761-7171
Fax
(773) 761-6714
NPI assigned
Sep 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2019

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

Authorized official

Name
Jennifer Pietri
Title
Insurance Coordinator
Phone
(773) 761-7171

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X 060003037 IL
Oral & Maxillofacial Surgery (D.M.D.)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 204E00000X Primary

Addresses

Primary practice location

2440 W Peterson Ave
Chicago, IL 60659-4113

Mailing address

2440 W Peterson Ave
Chicago, IL 60659-4113
Phone (773) 761-7171

Other practice location 1

4905 Old Orchard Ctr Ste 610
Skokie, IL 60077-1465
Phone (847) 676-9300

Other names 1

  • Oral Surgery Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090420000012 IL Part B Supplier - Clinic/Group Practice 2961559547 Receives reassigned benefits from 3 practitioners
Practice locations: Chicago, IL; Skokie, IL

National Provider Directory

National Provider Directory

Locations

2440 W Peterson Ave
Chicago, IL 60659
Phone (773) 761-7171

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575849600000",
    "number": "1316044837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2440 W PETERSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594113",
            "telephone_number": "773-761-7171",
            "fax_number": "773-761-6714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2440 W PETERSON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594113",
            "telephone_number": "773-761-7171",
            "fax_number": "773-761-6714"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4905 Old Orchard Ctr Ste 610",
            "address_purpose": "LOCATION",
            "city": "Skokie",
            "state": "IL",
            "postal_code": "600771465",
            "country_code": "US",
            "telephone_number": "847-676-9300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EVASKUS AND HERZOG, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-19",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A",
        "authorized_official_last_name": "PIETRI",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "773-761-7171"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": "060003037",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oral Surgery Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oral Surgery Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.