NPIMap

Individual provider Active NPI

Katherine K Katsoyannis, M.D.

  • Specialist
  • Park Ridge, IL
National Provider Identifier
1023123015
Registry record updated Dec 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
036096130 Issued in IL
Practice address
1600 Dempster St
Suite 120
Park Ridge, IL 60068-1109
Phone
(847) 299-7888
Fax
(847) 299-7844
NPI assigned
Aug 20, 2006
Last updated
Dec 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 18, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 036096130 IL Primary

Addresses

Primary practice location

1600 Dempster St
Suite 120
Park Ridge, IL 60068-1109

Mailing address

1600 Dempster St
Suite 120
Park Ridge, IL 60068-1109
Phone (847) 299-7888

Other identifiers 1

IdentifierTypeStateIssuer
036096130MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kkatsoyannis257856@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040510000636 IL Practitioner - Internal MedicinePractitioner - Geriatric Medicine 0345239976 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Geriatric Medicine
Education
Icahn School of Medicine at Mount Sinai, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geri Care LTDGroup PAC ID 5991794513, 12 clinicians

Practice addresses (Care Compare)

1600 W Dempster St
Suite 120
Park Ridge, IL 60068-1171
Phone (847) 590-1500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Gericare, LTD. Past Accepting new patients
Gericare, LTD Past Accepting new patients
Seneca Nursing Home, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kkatsoyannis257856@direct.myadvocateaurora.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639785600000",
    "number": "1023123015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 DEMPSTER ST",
            "address_2": "SUITE 120",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681109",
            "telephone_number": "847-299-7888",
            "fax_number": "847-299-7844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 DEMPSTER ST",
            "address_2": "SUITE 120",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681109",
            "telephone_number": "847-299-7888",
            "fax_number": "847-299-7844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATSOYANNIS",
        "first_name": "KATHERINE",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-20",
        "last_updated": "2021-12-18",
        "certification_date": "2021-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036096130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036096130",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkatsoyannis257856@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1600 Dempster St",
            "address_2": "Suite 120",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681109",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1600 Dempster St",
            "address_2": "Suite 120",
            "city": "Park Ridge",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600681109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

Verify at the official NPI Registry.