Individual provider Active NPI

Isaac J Kirstein, DO

  • Internal Medicine Physician
  • Chicago Heights, IL
National Provider Identifier
1114988425
Registry record updated Dec 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-100642 Issued in IL
Practice address
333 Dixie Hwy
Chicago Heights, IL 60411-1790
Phone
(708) 756-0100
Fax
(708) 709-6112
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036-100642 IL Primary

Addresses

Primary practice location

333 Dixie Hwy
Chicago Heights, IL 60411-1790

Mailing address

333 Dixie Hwy
Chicago Heights, IL 60411-1790
Phone (708) 709-6396

Other identifiers 3

IdentifierTypeStateIssuer
010019826MedicaidVA
279560OtherVAANTHEM BLUE CROSS
4673170001OtherILDMERC

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 Osteopathy

State licenses

LicenseStateTypeSpecialty
036-100642ILMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325030400000",
    "number": "1114988425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 DIXIE HWY",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604111790",
            "telephone_number": "708-709-6396",
            "fax_number": "708-709-6112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 DIXIE HWY",
            "city": "CHICAGO HEIGHTS",
            "state": "IL",
            "postal_code": "604111790",
            "telephone_number": "708-756-0100",
            "fax_number": "708-709-6112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRSTEIN",
        "first_name": "ISAAC",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2011-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-100642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010019826",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "279560",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "4673170001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2011; 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.