Active NPI
Nicholas G Stiso, MD
- Internal Medicine Physician
- Chicago, IL
National Provider Identifier
1114928835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 036-072335
- Practice address
- 47 W Polk St
Suite G
Chicago, IL 60605-2000 - Phone
- (312) 922-3409
- Fax
- (312) 583-1712
- NPI assigned
- Aug 3, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036-072335 | IL | Primary |
| Internal Medicine Physician | 207R00000X | 4301049152 | MI |
Addresses
Primary practice location
47 W Polk St
Suite G
Chicago, IL 60605-2000
Mailing address
PO Box 1152
La Grange Park, IL 60526-9252
Phone (708) 352-1202
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110084980 | Other | IL | RAILROAD MEDICARE |
| 31604458 | Other | IL | BLUE CROSS BLUE SHIELD |
| 36072335 | Medicaid | IL | |
| 950150135 | Other | IL | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-072335 | IL | MD | Internal Medicine Physician |
| 4301049152 | MI | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457568000000",
"number": "1114928835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1152",
"city": "LA GRANGE PARK",
"state": "IL",
"postal_code": "605269252",
"telephone_number": "708-352-1202",
"fax_number": "708-352-7311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "47 W POLK ST",
"address_2": "SUITE G",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606052000",
"telephone_number": "312-922-3409",
"fax_number": "312-583-1712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STISO",
"first_name": "NICHOLAS",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-03",
"last_updated": "2016-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036-072335",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "4301049152",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "110084980",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "31604458",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "36072335",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "950150135",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.