Jack E Nissim, M./D.

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

D0012942 Issued in MD

Practice address

7505 Osler Dr
409
Towson, MD 21204-7736

Phone

(410) 321-5651

Fax

(410) 583-0134

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346112000000",
    "number": "1316029291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 REDLAND CT",
            "address_2": "SUITE 208",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173290",
            "telephone_number": "410-494-7921",
            "fax_number": "410-902-8247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7505 OSLER DR",
            "address_2": "409",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212047736",
            "telephone_number": "410-321-5651",
            "fax_number": "410-583-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSIM",
        "first_name": "JACK",
        "middle_name": "E",
        "credential": "M./D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2012-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "MD",
            "license": "D0012942",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MD",
            "license": "D0012942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE MCO",
            "identifier": "4800034",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "789201200",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE/FEP",
            "identifier": "0005  E554",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "34438002  420A",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "274550",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "290010917",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Munoz, LCSW-C, LLC
• Lois E Nielsen, MD
• Tsira Nikoleishvili
• Maryam Nisa
• Javariya Nisar
• Niu Dentistry Towson LLC
• Susan Njenga, CRNA
• Afor Njoh
• Mark D Noar, M.D.
• Andrea Annelia Noel, LMSW

• Pulmonary Disease Physician in Towson, MD
• Providers in Towson, MD by specialty
• Pulmonary Disease Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.