Active NPI
John Szydelko, DDS
- Dentist
- Blue Island, IL
National Provider Identifier
1407807506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- Practice address
- 12059 Western Ave
Blue Island, IL 60406 - Phone
- (708) 371-3844
- Fax
- (708) 371-0059
- NPI assigned
- May 13, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | IL | Primary |
Addresses
Primary practice location
12059 Western Ave
Blue Island, IL 60406
Mailing address
12059 Western Ave
Blue Island, IL 60406
Phone (708) 371-3844
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150318000632 | IL | Order and Referring Only - Oral Surgery | 6800113549 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019016372 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Island Smiles PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Blue Island Smiles Family Dentistry
- General Practice Dentistry
- Blue Island, IL
- NPI 1942842810
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407807506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12059 WESTERN AVE",
"city": "BLUE ISLAND",
"state": "IL",
"postal_code": "60406",
"telephone_number": "708-371-3844",
"fax_number": "708-371-0059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12059 WESTERN AVE",
"city": "BLUE ISLAND",
"state": "IL",
"postal_code": "60406",
"telephone_number": "708-371-3844",
"fax_number": "708-371-0059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SZYDELKO",
"first_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blue Island, IL
- SSM Regional Health Services Owning and Operating St Francis Hospital (St. Francis Hospital & Health Center)
- Raymond Jerome Stadt, ATC
- Ashley Stalter
- Gwendolyn Stevens
- Rachel Swale
- Joseph Tanke
- Kimberley Jane Tarcak, MSW
- Jesse Taylor, LMT
- The Thresholds (South Suburbs Blue Island Apartments)
- The Thresholds (South Suburbs Residential)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.