Active NPI
Tyler James Boutsikakis
- Hearing Instrument Specialist
- Lake in the Hills, IL
National Provider Identifier
1740059260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hearing Instrument Specialist
- License
- 3553
- Practice address
- 4 Cedar Ridge Dr Ste a
Lake in the Hills, IL 60156-4712 - Phone
- (847) 458-2527
- NPI assigned
- Dec 26, 2023
- 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 |
|---|---|---|---|---|
| Hearing Instrument Specialist | 237700000X | 3553 | IL | Primary |
Addresses
Primary practice location
4 Cedar Ridge Dr Ste a
Lake in the Hills, IL 60156-4712
Mailing address
131 Enterprise Rd
Johnstown, NY 12095-3326
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3553 | IL | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chicago Hearing LLC | Current | Accepting new patients |
Locations
4 Cedar Ridge Dr
Ste A
Lake in the Hills, IL 60156
Phone (847) 458-2527
131 Enterprise Rd
Johnstown, NY 12095
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703548800000",
"number": "1740059260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 ENTERPRISE RD",
"city": "JOHNSTOWN",
"state": "NY",
"postal_code": "120953326"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 CEDAR RIDGE DR STE A",
"city": "LAKE IN THE HILLS",
"state": "IL",
"postal_code": "601564712",
"telephone_number": "847-458-2527"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUTSIKAKIS",
"first_name": "TYLER",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-12-26",
"last_updated": "2023-12-26",
"certification_date": "2023-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "237700000X",
"taxonomy_group": "",
"desc": "Hearing Instrument Specialist",
"state": "IL",
"license": "3553",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake in the Hills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.