Active NPI
Boris Kusnetzow, M.D.
- Family Medicine Physician
- Chicago, IL
National Provider Identifier
1285702357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036071405
- Practice address
- 6642 S Ashland Ave
Chicago, IL 60636-3022 - Phone
- (773) 776-3500
- Fax
- (773) 776-8534
- NPI assigned
- Nov 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036071405 | IL | Primary |
Addresses
Primary practice location
6642 S Ashland Ave
Chicago, IL 60636-3022
Mailing address
6642 S Ashland Ave
Chicago, IL 60636-3022
Phone (773) 776-3500
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 |
|---|---|---|---|---|
| I20120419000135 | IL | Practitioner - General Practice | 4284895285 | Practice locations: Chicago, IL |
Care Compare profile
Medicare Care Compare- Specialty
- General Practice
- Education
- Other, 1976
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
6642 S Ashland Ave
Chicago, IL 60636-3022
Phone (773) 776-3500
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036071405 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285702357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6642 S ASHLAND AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606363022",
"telephone_number": "773-776-3500",
"fax_number": "773-776-8534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6642 S ASHLAND AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606363022",
"telephone_number": "773-776-3500",
"fax_number": "773-776-8534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUSNETZOW",
"first_name": "BORIS",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036071405",
"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 8, 2007; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.