Kieran Joseph Nicholson, M.D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

036-076743 Issued in IL

Practice address

7803 Drew Ave
Burr Ridge, IL 60527-6946

Phone

(630) 650-8392

Fax

(630) 317-3310

NPI assigned

Aug 1, 2006

Last updated

Nov 29, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Dr. Kieran Joseph Nicholson Professional name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Ascension NE Wisconsin, Inc

  dba Ascension NE Wisconsin-St Elizabeth Campus

  • General Acute Care Hospital
  • Appleton, WI
  • NPI 1407803638
  Medicare reassignment NPD
• Ascension NE Wisconsin, Inc

  dba Ascension NE Wisconsin-Mercy Campus

  • General Acute Care Hospital
  • Oshkosh, WI
  • NPI 1912527193
  NPD
• Pulmonary and Critical Care Physicians PC

  • Specialist
  • Berwyn, IL
  • NPI 1265514202
  NPD (past)

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290988800000",
    "number": "1205843653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7803 DREW AVE",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276946",
            "telephone_number": "630-650-8392",
            "fax_number": "630-317-3310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7803 DREW AVE",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276946",
            "telephone_number": "630-650-8392",
            "fax_number": "630-317-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "KIERAN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2010-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036-076743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036076743",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "036076743",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE ID",
            "identifier": "110216107",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIERAN",
            "last_name": "NICHOLSON",
            "middle_name": "JOSEPH",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Cory A Nellis, MOT, OTR/L
• Lynn Marie Nemec
• Gillian M Newstead, MD
• Amanda NG, DPT
• Martin K Nicholas, MD
• Donata Nieciunski, M.S., CCC-SLP
• Katelyn Nieman, NP
• Gina Nikoleit
• Shahbaz Shahid Nisar, MD
• Nivein Care

• Pulmonary Disease Physician in Burr Ridge, IL
• Providers in Burr Ridge, IL by specialty
• Pulmonary Disease Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2010; 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.

Verify at the official NPI Registry.