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Deactivated NPI 1174647291 Deactivated / Inactive NPI Male Practitioner

Dr. Blaine Patrick Cusck , BS, DDS

Dentist - General Practice • Countryside, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Blaine Cusck has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date March 16, 2007
NPI Deactivation Date March 03, 2022
Total Practice Duration ~15 Years of Practice (2007 – 2022)

Professional Overview & Biography Verified Profile Summary

Dr. Blaine Cusck, BS, DDS was a registered Dentist - General Practice practicing in Countryside, IL. Throughout an active medical career spanning 15 years, Dr. Cusck provided care at the practice location at 475 W 55TH ST until profile deactivation on 2022-03-03.

Practice Location & Contact Primary Location

Practice Address

475 W 55th St
Suite 207

Countryside, IL 605253564

Telephone 7084820300
Fax 7084820541
Associated Practice Facility / Clinic
🏢 Allbest Home Health Care Inc Facility NPI 1184606121

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Countryside, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.0 Yrs
Regional Practice Density
7 Specialists

Practicing in Countryside, IL (5581 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
Dr. Richard Kohn , DDS MS

Dentist - Endodontics

NPI 1336315274

DDSMS

Dr. Peter Hasiakos , DDS

Dentist - General Practice

NPI 1467549824

Doctor of Dental Surgery

Dr. Gary Taylor , DDS

Dentist - Endodontics

NPI 1972779056

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events
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NPI Profile Deactivated March 03, 2022

Record deactivated on March 03, 2022

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Updated Business Mailing Address June 19, 2020

Registered at 475 W 55TH ST STE 207, COUNTRYSIDE, IL 605253566 (Tel: 7084820300)

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 19, 2020

Dentist (License #019019211 in ID)

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 475 W 55TH ST, SUITE 207, COUNTRYSIDE, IL 605253564 (Tel: 7084820300)

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Updated Business Mailing Address July 08, 2007

Registered at 475 W 55TH ST, SUITE 207, COUNTRYSIDE, IL 605253564 (Tel: 7084820300)

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Provider Name / Credentials Updated July 08, 2007

Recorded as BLAINE CUSCK, B.S., D.D.S.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist

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Initial NPI Registration & Enumeration March 16, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1174647291
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 16, 2007
Last Update: July 08, 2007
Deactivation Date: March 03, 2022

Mailing Address

475 W 55th St, Suite 207

Countryside, IL 605253564

Phone: 7084820300

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.