DR. CORNELL MCCULLOM III D.D.S., M.D.
NPI 1619124807
Dentist - Oral and Maxillofacial Surgery in Chicago, IL

Q: What is Cornell Mccullom's NPI number?

The NPI number for Cornell Mccullom is 1619124807. It was assigned to this individual provider in the NPPES registry on August 19, 2008.

Q: What is Cornell Mccullom's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Q: When was this NPI record last updated?

The NPPES record for Cornell Mccullom was last updated on August 19, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.

Active since August 19, 2008PECOS Enrolled

820 E 87TH ST, STE. 201, CHICAGO, IL 60619(773) 488-3738(773) 874-6575 Get Directions Write a Review

NPPES record last updated: August 19, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Cornell Mccullom Iii D.d.s., M.d. NPPES

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

DR. CORNELL MCCULLOM III D.D.S., M.D. (NPI 1619124807) is an individual oral and maxillofacial surgery provider in Chicago, Illinois, licensed in Illinois (021001488) and active in the NPI registry since August 2008. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619124807

Entity TypeIndividualMale

Primary Taxonomy1223S0112X

Provider Legal NameDR. CORNELL MCCULLOM IIICredential: D.D.S., M.D.

Location Address820 E 87TH ST, STE. 201Chicago, IL 60619-6253

Mailing Address820 E 87th St, Ste. 201Chicago, IL 60619-6253 · (773) 488-3738 · Fax (773) 874-6575

Phone(773) 488-3738

Fax(773) 874-6575

Sole ProprietorNo

Enumeration DateAugust 19, 2008

✔ NPI 1619124807 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in IL · 021001488

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

820 E 87TH ST, Chicago, IL 60619

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Cornell Mccullom Iii D.d.s., M.d. 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 60619 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 4

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

YETTA G MCCULLOM DDS, MA

Dentist (Periodontics)

820 E 87TH ST, STE 201
CHICAGO, IL 60619

Cook County (773) 488-3738

ROBIN L. FERGUSON DDS PC

Dentist (General Practice)

820 E 87TH ST, SUITE 201
CHICAGO, IL 60619

Cook County (773) 488-9075

ROBIN L FERGUSON DDS

Dentist

820 E 87TH ST, STE 201
CHICAGO, IL 60619

Cook County (773) 488-9075

DRS. MCCULLOM P.C.

Dentist (Periodontics)

820 E 87TH ST, SUITE 201
CHICAGO, IL 60619

Cook County (773) 488-3738

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 Cornell Mccullom's NPI number?

The NPI number for Cornell Mccullom is 1619124807. It was assigned to this individual provider in the NPPES registry on August 19, 2008.

Where is Cornell Mccullom located?

Cornell Mccullom practices at 820 E 87th St Ste. 201, Chicago, IL 60619. The listed phone number is (773) 488-3738.

What is Cornell Mccullom's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Cornell Mccullom enrolled in Medicare?

Yes. Cornell Mccullom is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Cornell Mccullom was last updated on August 19, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.