MARK ANTHONY CHISHOM, DMD — NPI 1417908328 (Licensed & Credentialed Allopathic & Osteopathic Physicians — Oral & Maxillofacial Surgery in ELGIN, SC)

CMS-1500 Box 24J / 33a • NPI

1417908328

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

204E00000X (CMS 02)

Licensed & Credentialed Allopathic & Osteopathic Physicians — Oral & Maxillofacial Surgery

Box 32 Service Location & ZIP+4

102 BUCKTHORN CIR, ELGIN, SC, 29045-8695

✓ 9-Digit EDI 837 ZIP+4 (29045-8695)

Practice Phone & Referral Fax

(803) 477-4909

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1417908328 (MARK ANTHONY CHISHOM, DMD) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1417908328` (NPI-1 Individual Practitioner)
Provider / Legal Name	MARK ANTHONY CHISHOM, DMD
Plain-English Specialty	Licensed & Credentialed Allopathic & Osteopathic Physicians — Oral & Maxillofacial Surgery NUCC Code: `204E00000X` (Oral & Maxillofacial Surgery)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	102 BUCKTHORN CIR, ELGIN, SC, 29045-8695
Practice Telephone / Fax	Tel: (803) 477-4909
Administrative Mailing Address	102 BUCKTHORN CIR, ELGIN, SC, 29045-8695
Enumeration & Last Sync	Enumerated: 2006-05-15 \| CMS Record Updated: 2015-04-02

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

102 BUCKTHORN CIR, ELGIN, SC, 29045-8695

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Plain-English Taxonomy & CMS Crosswalk (204E00000X)

What Does Taxonomy Code 204E00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 204E00000X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Oral & Maxillofacial Surgery"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 02 (Physician/General Surgery) • CMS Code 85 (Physician/Maxillofacial Surgery)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Oral & Maxillofacial Surgery for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MARK ANTHONY CHISHOM, DMD)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`204E00000X` — Oral & Maxillofacial Surgery Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Oral & Maxillofacial Surgery	State: SC \| License: `3253` \| Primary: Yes (Primary)
`1223S0112X` — Dentist, Oral and Maxillofacial Surgery Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: GA \| License: `DN014013` \| Primary: Secondary

Medical Billing, RCM & Hospital Credentialing Teams:

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MARK ANTHONY CHISHOM, DMD (NPI #1417908328)