JACK DYER CROUCH III
NPI 1215772033
Dermatology in Chicago, IL

Active since June 25, 2024PECOS Enrolled
4646 N MARINE DR, CHICAGO, IL 60640(773) 564-5225 Get Directions Write a Review

NPPES record last updated: June 25, 2024. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Jack Dyer Crouch Iii NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK DYER CROUCH III (NPI 1215772033) is an individual dermatology provider in Chicago, Illinois, licensed in Illinois (125.084866) and active in the NPI registry since June 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1215772033
Entity TypeIndividualMale
Primary Taxonomy207N00000X
Provider Legal NameJACK DYER CROUCH III
Location Address4646 N MARINE DRChicago, IL 60640-5759
Mailing Address4646 N Marine DrChicago, IL 60640-5759 · (773) 564-5225
Sole ProprietorNo
Enumeration DateJune 25, 2024
NPPES CertifiedJune 25, 2024
NPI 1215772033 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License Licensed in IL · 125.084866
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
4646 N MARINE DR, Chicago, IL 60640

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Jack Dyer Crouch Iii is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60640 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.06 typical visit price
range $60.08 – $183.39
Typical copayment $23.51 (range $15.02 – $45.84)
Most-billed visit code 99203
Established Patient
$74.80 typical visit price
range $18.97 – $148.12
Typical copayment $18.70 (range $4.74 – $37.03)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine
4646 N MARINE DR
CHICAGO, IL 60640
Internal Medicine
4646 N MARINE DR
CHICAGO, IL 60640
Anesthesiology
4646 N MARINE DR
CHICAGO, IL 60640
Chronic Disease Hospital
4646 N MARINE DR
CHICAGO, IL 60640
Orthopaedic Surgery
4646 N MARINE DR, SUITE 3A
CHICAGO, IL 60640
Psychiatry & Neurology (Neurology)
4646 N MARINE DR
CHICAGO, IL 60640
Speech-Language Pathologist
4646 N MARINE DR, OUTPATIENT PHYSICAL THERAPY DEPT. 1ST FLOOR
CHICAGO, IL 60640
Internal Medicine
4646 N MARINE DR
CHICAGO, IL 60640

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Crouch's NPI number?

The NPI number for Jack Crouch is 1215772033. It was assigned to this individual provider in the NPPES registry on June 25, 2024.

Where is Jack Crouch located?

Jack Crouch practices at 4646 N Marine Dr, Chicago, IL 60640. The listed phone number is (773) 564-5225.

What is Jack Crouch's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Jack Crouch enrolled in Medicare?

Yes. Jack Crouch is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jack Crouch was last updated on June 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.