Timothy A Kisla, DO

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

036097974 Issued in IL

Practice address

1870 Silver Cross Blvd
Suite 110
New Lenox, IL 60451-8639

Phone

(815) 485-2727

Fax

(815) 485-3034

NPI assigned

Jun 8, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Midwestern University, Chicago College of Osteopathic Med, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Eye Care SCGroup PAC ID 0446145577, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Silver Cross Hospital and Medical Centers Hospital, New Lenox, IL, CCN 140213

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Advanced Eye Care SC

  • Ophthalmology Physician
  • New Lenox, IL
  • NPI 1831154947

  IL, Ophthalmology

  Medicare reassignment Care Compare group NPD Authorized official
• Advanced Eye Care SC

  • Durable Medical Equipment & Medical Supplies
  • New Lenox, IL
  • NPI 1770712531
  NPD Authorized official
• Ocular Partners PLLC

  • Ophthalmic Technician/Technologist
  • Homewood, IL
  • NPI 1295792901
  NPD (past)
• Tennenbaum and Anstadt, LTD

  • Eyewear Supplier
  • Melrose Park, IL
  • NPI 1740530971
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Silver Cross Hospital & Medical Centers

  • Rehabilitation Hospital Unit
  • New Lenox, IL
  • NPI 1003933797

  Hospital

  Care Compare affiliation
• Silver Cross Hospital & Medical Centers

  • General Acute Care Hospital
  • New Lenox, IL
  • NPI 1568553519

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1477557445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1870 SILVER CROSS BLVD",
            "address_2": "SUITE 110",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604518639",
            "telephone_number": "815-485-2727",
            "fax_number": "815-485-3034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870 SILVER CROSS BLVD",
            "address_2": "SUITE 110",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604518639",
            "telephone_number": "815-485-2727",
            "fax_number": "815-485-3034"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15900 W 127th St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Lemont",
            "state": "IL",
            "postal_code": "604392912",
            "country_code": "US",
            "telephone_number": "815-485-2727",
            "fax_number": "815-485-3034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISLA",
        "first_name": "TIMOTHY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036097974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036097974",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00061462",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peyton Marie King
• Courtney Kinney, PTA
• Kirchner Foot & Ankle
• Kyle Kirchner, DPM
• Paul Bernard Kirchner, D.P.M.
• Srinarong Kittisopikul, M.D., PHD
• Kathryn Ann Kittler, PT
• Alex Rae Kixmiller, DC
• Nicole Klaric, LPC
• Katherine Kline, LCSW, CRSS

• All providers in New Lenox, IL
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; 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.