Kenneth Richard Nissim, M.D.

Primary specialty

Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X

License

036170811 Issued in IL

Practice address

1253 N Alpine Rd
Rockford, IL 61107-2201

Phone

(779) 696-9201

Fax

(815) 397-9667

NPI assigned

Sep 26, 2005

Last updated

Dec 11, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL, IL2 enrollments

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 2

Merit-based Incentive Payment System (MIPS)

Final score

81.51 of 100Reported as group

Quality

83.2

Promoting interoperability

77

Improvement activities

40

Cost

71.7

Merit-based Incentive Payment System (MIPS)

Final score

86.12 of 100Reported as group

Quality

64.08

Promoting interoperability

98

Improvement activities

40

Cost

76.83

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: knissim8076@direct.med.miami.edu

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

• Swedishamerican Hospital

  dba SwedishAmerican Medical Group

  • Family Medicine Physician
  • Rockford, IL
  • NPI 1962451732

  Otolaryngology

  Medicare reassignment NPD
• Lakeland Regional Health Systems, Inc.

  • Multi-Specialty Clinic/Center
  • Lakeland, FL
  • NPI 1497748743
  Medicare reassignment NPD
• University of Miami

  dba UMiami Medicine - Hepatology

  • Hepatology Physician
  • Miami, FL
  • NPI 1013967827
  Medicare reassignment NPD
• Swedishamerican Hospital

  • Community/Retail Pharmacy
  • Rockford, IL
  • NPI 1306635982
  NPD
• Swedishamerican Hospital

  • Family Medicine Physician
  • Davis Junction, IL
  • NPI 1407908189
  NPD
• University of Miami

  dba UMiami Medicine Multi Specialty Services

  • Internal Medicine Physician
  • Miami Beach, FL
  • NPI 1124768627
  NPD
• University of Miami

  dba UMiami Medicine - Audio Speech

  • Otolaryngology Physician
  • Miami, FL
  • NPI 1689623100
  NPD
• University of Miami

  dba UMiami Medicine - Sinus and Allergy

  • Otolaryngic Allergy Physician
  • Miami, FL
  • NPI 1386694115
  NPD (past)

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1447246392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 NW 14TH ST",
            "address_2": "5TH FLOOR",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331362107",
            "telephone_number": "305-243-3564",
            "fax_number": "305-243-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1253 N ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611072201",
            "telephone_number": "779-696-9201",
            "fax_number": "815-397-9667"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8932 SW 97th Ave",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331761936",
            "country_code": "US",
            "telephone_number": "305-270-3740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NISSIM",
        "first_name": "KENNETH",
        "middle_name": "RICHARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME85561",
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "IL",
            "license": "036170811",
            "primary": true
        },
        {
            "code": "207YS0012X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Sleep Medicine",
            "state": "FL",
            "license": "ME85561",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2675617-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vanessa Nienhouse, M.D.
• Kathleen M Niesen Zucchi, LCSW
• Jose L Nieves, OPTICAL
• Kumud Nigam, M.D.
• Nissi Corp (The Good Feet Store)
• Jerica Nitz, MS, ACSM-RCEP
• Stephen T Nitz, M.D.
• Marta Njos
• Edward Bruce Noakes III, DMD, MS
• Stephanie Nold, M.S., CCC-SLP/L

• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; 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.

Verify at the official NPI Registry.