NPIMap

Individual provider Active NPI

Michael James Liston Jr., M.D.

  • Family Medicine Physician
  • Morris, IL
National Provider Identifier
1235362971
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036.129326 Issued in IL
Practice address
100 Gore Rd
Morris, IL 60450-9466
Phone
(815) 364-8919
Fax
(815) 942-4913
NPI assigned
Aug 28, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036.129326 IL Primary

Addresses

Primary practice location

100 Gore Rd
Morris, IL 60450-9466

Mailing address

725 School St Ste a
Morris, IL 60450-1207
Phone (815) 705-5605

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130814000146 IL Practitioner - Family PracticePractitioner - Emergency Medicine 9436391877 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Northeastern Ohio University College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of ChicagoGroup PAC ID 7719899426, 1,674 clinicians

Practice addresses (Care Compare)

5841 S Maryland Ave
Chicago, IL 60637-1443
Phone (888) 824-0200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.129326ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Morris Hospital Current Accepting new patients
Morris Hospital CurrentSince Sep 14, 2015 Accepting new patients
The University of Chicago Medical Center CurrentSince Mar 1, 2020 Accepting new patients
The University of Chicago Medical Center CurrentSince Mar 1, 2020 Accepting new patients
Morris Hospital Current Accepting new patients
University of Chicago CurrentSince Mar 1, 2020 Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

150 W High St
Morris, IL 60450
Phone (815) 942-2129

100 Gore Rd
Morris, IL 60450
Phone (815) 364-8919

725 School St
Ste A
Morris, IL 60450

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

14290 S La Grange Rd
Orland Park, IL 60462
Phone (708) 299-1352

12251 S 80th Ave
Palos Heights, IL 60463
Phone (708) 361-4500

Interoperability endpoints

  • Direct secure messaging: mliston191928@uchospital.direct-ci.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540252800000",
    "number": "1235362971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 SCHOOL ST STE A",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604501207",
            "telephone_number": "815-705-5605",
            "fax_number": "815-941-4363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GORE RD",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604509466",
            "telephone_number": "815-364-8919",
            "fax_number": "815-942-4913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LISTON",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-28",
        "last_updated": "2018-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.129326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morris, IL

Sources for this page

Verify at the official NPI Registry.