Active NPI
Michael A Derosa, HIS
- Hearing Instrument Specialist
- Westmont, IL
National Provider Identifier
1215442827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hearing Instrument Specialist
- License
- 3164
- Practice address
- 200 E Chicago Ave Ste 102
Westmont, IL 60559-1756 - Phone
- (630) 810-1340
- Fax
- (630) 598-0318
- NPI assigned
- Dec 5, 2017
- Last updated
- Jul 23, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Hearing Instrument Specialist | 237700000X | 3164 | IL | Primary |
Addresses
Primary practice location
200 E Chicago Ave Ste 102
Westmont, IL 60559-1756
Mailing address
215 Shuman Blvd Ste 401
Naperville, IL 60563-8123
Phone (630) 303-5380
Other practice location 1
1530 N Randall Rd Ste 110
Elgin, IL 60123-7878
Phone (847) 741-2818
Other practice location 2
1816 S West Ave
Freeport, IL 61032-6712
Phone (815) 233-2535
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3164 | IL | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Connect Hearing Inc | Hearing Instrument Specialist | Past | Accepting new patients |
| Connect Hearing, Inc. | Hearing Instrument Specialist | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563840000000",
"number": "1215442827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 SHUMAN BLVD STE 401",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605638123",
"telephone_number": "630-303-5380",
"fax_number": "630-303-5385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E CHICAGO AVE STE 102",
"city": "WESTMONT",
"state": "IL",
"postal_code": "605591756",
"telephone_number": "630-810-1340",
"fax_number": "630-598-0318"
}
],
"practiceLocations": [
{
"address_1": "1530 N Randall Rd Ste 110",
"address_purpose": "LOCATION",
"city": "Elgin",
"state": "IL",
"postal_code": "601237878",
"country_code": "US",
"telephone_number": "847-741-2818",
"fax_number": "847-741-8694",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1816 S West Ave",
"address_purpose": "LOCATION",
"city": "Freeport",
"state": "IL",
"postal_code": "610326712",
"country_code": "US",
"telephone_number": "815-233-2535",
"fax_number": "815-232-7683",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DEROSA",
"first_name": "MICHAEL",
"middle_name": "A",
"credential": "HIS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-12-05",
"last_updated": "2019-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "237700000X",
"taxonomy_group": "",
"desc": "Hearing Instrument Specialist",
"state": "IL",
"license": "3164",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westmont, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.