Andrew Gattuso, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

019022253 Issued in IL

Practice address

6718 Cermak Rd
Berwyn, IL 60402-2215

Phone

(708) 484-4404

Fax

(708) 484-9790

NPI assigned

Jun 30, 2008

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

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)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214784000000",
    "number": "1952563967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6718 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022215",
            "telephone_number": "708-484-4404",
            "fax_number": "708-484-9790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6718 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022215",
            "telephone_number": "708-484-4404",
            "fax_number": "708-484-9790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATTUSO",
        "first_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019022253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Berwyn, IL
• Providers in Berwyn, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; 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.