Active NPI
Safwat G. Iskander, M.D.
- Pediatrics Physician
- Kankakee, IL
National Provider Identifier
1194781112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036102421
- Practice address
- 400 N Wall St
Suite 312
Kankakee, IL 60901-2940 - Phone
- (815) 933-3200
- Fax
- (815) 933-3557
- NPI assigned
- Apr 26, 2006
- Last updated
- Sep 17, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036102421 | IL | Primary |
Addresses
Primary practice location
400 N Wall St
Suite 312
Kankakee, IL 60901-2940
Mailing address
400 N Wall St
Suite 312
Kankakee, IL 60901-2940
Phone (815) 933-3200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036102421 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140311000337 | IL | Order and Referring Only - Pediatric Medicine | 8820228950 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036102421 | IL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gibson Community Hospital Association | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/GCCJBA/Endpoint/GCCJBA
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Gibson Area Hospital and Health Services
- Critical Access Hospital
- Gibson City, IL
- NPI 1114935681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347840000000",
"number": "1194781112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 N WALL ST",
"address_2": "SUITE 312",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609012940",
"telephone_number": "815-933-3200",
"fax_number": "815-933-3557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 N WALL ST",
"address_2": "SUITE 312",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609012940",
"telephone_number": "815-933-3200",
"fax_number": "815-933-3557"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISKANDER",
"first_name": "SAFWAT",
"middle_name": "G.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-26",
"last_updated": "2012-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036102421",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036102421",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kankakee, IL
- Illinois Department of Human Services
- Indigo Butterfly Counseling and Wellness PLLC
- Internal Medicine Specialists of Kankakee SC
- Iroquois Mental Health Center
- Iroquois Mental Health Center
- Heather Renee Iwanus, OCCUPATIONAL THERAPI
- J & C Webber, Inc. (audibel center for hearing excellence)
- J. Michael Krisko DDS, LTD.
- J's Medical Services
- Alyce F Jackson, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.