Active NPI
Carol E. Talisse, PA
- Physician Assistant
- Chicago, IL
National Provider Identifier
1174757983
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085003354
- Practice address
- 5115 N Francisco Ave
Chicago, IL 60625-3611 - Phone
- (773) 271-2225
- Fax
- (773) 271-1145
- NPI assigned
- May 7, 2009
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 085-003354 | IL | |
| Physician Assistant | 363A00000X | 085003354 | IL | Primary |
Addresses
Primary practice location
5115 N Francisco Ave
Chicago, IL 60625-3611
Mailing address
5019 N Mozart St
Chicago, IL 60625-3615
Phone (773) 293-3223
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 085-003354 | Other | IL | LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ctalisse277178@direct.northshore.org |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-003354 | IL | MD | Surgical Physician Assistant |
Interoperability endpoints
- ctalisse277178@direct.northshore.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604016000000",
"number": "1174757983",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5019 N MOZART ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606253615",
"telephone_number": "773-293-3223",
"fax_number": "773-293-4197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5115 N FRANCISCO AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606253611",
"telephone_number": "773-271-2225",
"fax_number": "773-271-1145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TALISSE",
"first_name": "CAROL",
"middle_name": "E.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-07",
"last_updated": "2020-10-30",
"certification_date": "2020-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "IL",
"license": "085-003354",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085003354",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "085-003354",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ctalisse277178@direct.northshore.org",
"affiliation": "N",
"address_1": "5115 N Francisco Ave",
"city": "Chicago",
"state": "IL",
"country_code": "US",
"postal_code": "606253611",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Oct 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.