Individual provider Active NPI

Mark E Cichon, DO

  • Emergency Medicine Physician
  • Maywood, IL
National Provider Identifier
1629290655
Registry record updated May 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036073801 Issued in IL
Practice address
2160 S First Ave
EMS BLDG. RM. 2700
Maywood, IL 60153
Phone
(708) 327-2700
Fax
(708) 327-3474
NPI assigned
May 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036073801 IL
Emergency Medicine Physician 207P00000X 036073801 IL Primary

Addresses

Primary practice location

2160 S First Ave
EMS BLDG. RM. 2700
Maywood, IL 60153

Mailing address

2160 S First Ave
EMS BLDG. RM. 2700
Maywood, IL 60153
Phone (708) 327-2700

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mcichon25221@direct.luhs.org Direct

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100208000580 IL Practitioner - Emergency Medicine 8224083217 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Loyola University Medical Center CurrentSince May 1, 1996 Accepting new patients
Loyola University Medical Center CurrentSince May 1, 1996 Accepting new patients
Loyola University Medical Center Current Accepting new patients

Locations

2160 S 1st Ave
Rm 1739
Maywood, IL 60153

2160 S 1st Ave
Maywood, IL 60153
Phone (708) 216-4400

2160 S 1st Ave
Rm 2700
Maywood, IL 60153
Phone (708) 327-2700

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652832000000",
    "number": "1629290655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S FIRST AVE",
            "address_2": "EMS BLDG. RM. 2700",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-327-2700",
            "fax_number": "708-327-3474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S FIRST AVE",
            "address_2": "EMS BLDG. RM. 2700",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "60153",
            "telephone_number": "708-327-2700",
            "fax_number": "708-327-3474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICHON",
        "first_name": "MARK",
        "middle_name": "E",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2022-05-18",
        "certification_date": "2022-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036073801",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036073801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mcichon25221@direct.luhs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2160 S First Ave",
            "address_2": "EMS BLDG. RM. 2700",
            "city": "Maywood",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60153",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maywood, IL

Sources for this page

Verify at the official NPI Registry.