Patricia Bettina Cariaga Crisostomo, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019025133 Issued in IL

Practice address

3403 W Lawrence Ave Ste 202
Chicago, IL 60625-5162

Phone

(773) 539-1003

Fax

(773) 539-1036

NPI assigned

Jun 11, 2006

Last updated

Feb 12, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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

Practice roles

Locations

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.

• Humboldt Park Health

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1740417153
  Medicare reassignment NPD
• Smiledentist, P.C.

  • Dentist
  • Chicago, IL
  • NPI 1801290556
  NPD (past)

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676160000000",
    "number": "1437191871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 N LAKE SHORE DR APT 2712",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606134666",
            "telephone_number": "773-793-0836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3403 W LAWRENCE AVE STE 202",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606255162",
            "telephone_number": "773-539-1003",
            "fax_number": "773-539-1036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRISOSTOMO",
        "first_name": "PATRICIA",
        "middle_name": "BETTINA CARIAGA",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-11",
        "last_updated": "2023-02-12",
        "certification_date": "2023-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019025133",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019025133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antonio M Crisostomo, MD
• Elaine Crisostomo, LSW
• Elizabeth Crisostomo
• Lauren Crisostomo, LCPC
• Lolita Crisostomo, M.D.
• Meghan Marie Crisp
• Kelli Crispo
• Caitlin Crissey
• Lisa Cristia, LMT
• Eduardo Mauricio Cristiano-Hernandez

• General Practice Dentistry in Chicago, IL
• Providers in Chicago, 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 Feb 12, 2023; 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.