Active NPI
Randall Scott Yessenow, M.D.
- Plastic Surgery Physician
- Chicago, IL
National Provider Identifier
1144280785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 036.086614
- Practice address
- 60 E Delaware PL Ste 1400
Chicago, IL 60611-1806 - Phone
- (312) 202-9909
- NPI assigned
- Mar 27, 2006
- 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 |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 01039206 | IN | |
| Plastic Surgery Physician | 208200000X | 036.086614 | IL | Primary |
Addresses
Primary practice location
60 E Delaware PL Ste 1400
Chicago, IL 60611-1806
Mailing address
PO Box 405
Schererville, IN 46375-0405
Phone (219) 742-0990
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1859137007 | Other | IN | CIGNA PROVIDER NO. |
| 4411395 | Other | IN | AETNA PROVIDER NO. |
| 942359 | Other | IN | UNITED HEALTHCARE NO. |
| 88688 | Other | IN | ANTHEM PROVIDER NO. |
| 911-08053 | Other | IN | BC/BS OF IL PROVIDER NO. |
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 |
|---|---|---|---|
| 036.086614 | IL | MD | Plastic Surgery Physician |
| 01039206 | IN | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705968000000",
"number": "1144280785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 405",
"city": "SCHERERVILLE",
"state": "IN",
"postal_code": "463750405",
"telephone_number": "219-742-0990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 E DELAWARE PL STE 1400",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606111806",
"telephone_number": "312-202-9909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YESSENOW",
"first_name": "RANDALL",
"middle_name": "SCOTT",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-27",
"last_updated": "2024-01-23",
"certification_date": "2024-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "IN",
"license": "01039206",
"primary": false
},
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "IL",
"license": "036.086614",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA PROVIDER NO.",
"identifier": "1859137007",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROVIDER NO.",
"identifier": "4411395",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE NO.",
"identifier": "942359",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NO.",
"identifier": "88688",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS OF IL PROVIDER NO.",
"identifier": "911-08053",
"state": "IN"
}
],
"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 Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.