Individual provider Active NPI

Bissy Kumpuckal, NP

  • Family Nurse Practitioner
  • Darien, IL
National Provider Identifier
1053784645
Registry record updated Jan 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
209013257 Issued in IL
Practice address
2213 Hamilton LN
Darien, IL 60561-4346
Phone
(630) 689-6553
NPI assigned
Nov 5, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 209013257 IL Primary

Addresses

Primary practice location

2213 Hamilton LN
Darien, IL 60561-4346

Mailing address

1333 Butterfield Rd
Ste 130
Downers Grove, IL 60515-5641
Phone (630) 371-0133

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160121000248 IL Practitioner - Nurse Practitioner 6709189046 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

27650 Ferry Rd
Warrenville, IL 60555-3845
Phone (630) 225-2663

Hospital & facility affiliations

  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Northwestern Medicine Delnor Community Hospital Hospital, Geneva, IL, CCN 140211

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Oct 9, 2017 Accepting new patients
Central Dupage Physician Group CurrentSince Oct 9, 2017 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

27650 Ferry Rd
Ste 100
Warrenville, IL 60555
Phone (630) 225-2455

27650 Ferry Rd
Warrenville, IL 60555
Phone (630) 225-2345

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 3

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

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1446681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451952000000",
    "number": "1053784645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 BUTTERFIELD RD",
            "address_2": "STE 130",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605155641",
            "telephone_number": "630-371-0133",
            "fax_number": "630-371-0138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2213 HAMILTON LN",
            "city": "DARIEN",
            "state": "IL",
            "postal_code": "605614346",
            "telephone_number": "630-689-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUMPUCKAL",
        "first_name": "BISSY",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-05",
        "last_updated": "2016-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209013257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Darien, IL

Sources for this page

Verify at the official NPI Registry.