Active NPI
Kyra Nicholson
- Surgery Physician
- Chicago, IL
National Provider Identifier
1255992590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 125.074986
- Practice address
- 5841 S Maryland Ave # Mc6040
Chicago, IL 60637-1443 - Phone
- (773) 702-1000
- NPI assigned
- Jun 26, 2019
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 125.074986 | IL | Primary |
Addresses
Primary practice location
5841 S Maryland Ave # Mc6040
Chicago, IL 60637-1443
Mailing address
180 Harvester Dr Ste 110
Burr Ridge, IL 60527-6686
Other practice location 1
5841 S Maryland Ave # Mc1052
Chicago, IL 60637-1443
Phone (773) 702-6760
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 |
|---|---|---|---|---|
| I20190709001397 | IL | Order and Referring Only - General Surgery | 1557696846 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1561507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563235200000",
"number": "1255992590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 HARVESTER DR STE 110",
"city": "BURR RIDGE",
"state": "IL",
"postal_code": "605276686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5841 S MARYLAND AVE # MC6040",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606371443",
"telephone_number": "773-702-1000"
}
],
"practiceLocations": [
{
"address_1": "5841 S Maryland Ave # Mc1052",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606371443",
"country_code": "US",
"telephone_number": "773-702-6760",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NICHOLSON",
"first_name": "KYRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-26",
"last_updated": "2019-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "125.074986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"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 Jul 16, 2019; 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.