Individual provider Active NPI

Kushal Bikram Baniya, MD

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1285201061
Registry record updated Jun 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125078419 Issued in IL
Practice address
4646 N Marine Dr Ste 7100
Chicago, IL 60640-5759
Phone
(773) 564-5225
Fax
(773) 564-5226
NPI assigned
Jun 9, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125078419 IL Primary

Addresses

Primary practice location

4646 N Marine Dr Ste 7100
Chicago, IL 60640-5759

Mailing address

5917 Inverness Dr
Farmington, NM 87402-8704
Phone (773) 437-7028

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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

Enrollment IDStateProvider typePAC IDDetails
I20250717004585 NJ Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 9133522998

National Provider Directory

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

NPI Registry JSON

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1285201061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5917 INVERNESS DR",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874028704",
            "telephone_number": "773-437-7028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 N MARINE DR STE 7100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405759",
            "telephone_number": "773-564-5225",
            "fax_number": "773-564-5226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANIYA",
        "first_name": "KUSHAL",
        "middle_name": "BIKRAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-09",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125078419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.