Jonathan Michael Czyscon, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019030324 Issued in IL

Practice address

3320 Chicago Rd
South Chicago Heights, IL 60411-5423

Phone

(708) 248-5034

NPI assigned

Jul 20, 2015

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1437350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437350400000",
    "number": "1649655606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3320 CHICAGO RD",
            "city": "SOUTH CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604115423",
            "telephone_number": "708-248-5034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 CHICAGO RD",
            "city": "SOUTH CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604115423",
            "telephone_number": "708-248-5034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CZYSCON",
        "first_name": "JONATHAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-20",
        "last_updated": "2015-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019030324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019030324",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in South Chicago Heights, IL
• Providers in South Chicago Heights, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2015; 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.