NPIMap

Organization Active NPI

Nissi Corp

  • Durable Medical Equipment & Medical Supplies
  • Rockford, IL
National Provider Identifier
1063680064
Registry record updated Jun 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
212000137 Issued in IL
Legal business name
NISSI CORP
Practice address
5823 E Riverside Blvd
Rockford, IL 61114-4963
Phone
(815) 654-1900
NPI assigned
Feb 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2008

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

Authorized official

Name
Mr. Lawrence Edward Buckman III, CERTIFIED PEDORTHISTNPI 1093938359
Title
President
Phone
(815) 654-1900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 212000137 IL Primary

Addresses

Primary practice location

5823 E Riverside Blvd
Rockford, IL 61114-4963

Mailing address

5823 E Riverside Blvd
Rockford, IL 61114-4963
Phone (815) 654-1900

Other names 1

  • The Good Feet Store Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Nissi Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5823 E Riverside Blvd
Rockford, IL 61114
Phone (815) 654-1900

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212969600000",
    "number": "1063680064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5823 E RIVERSIDE BLVD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611144963",
            "telephone_number": "815-654-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5823 E RIVERSIDE BLVD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611144963",
            "telephone_number": "815-654-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NISSI CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2008-06-09",
        "status": "A",
        "authorized_official_last_name": "BUCKMAN",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-654-1900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "CERTIFIED PEDORTHIST"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "212000137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Good Feet Store",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.