Active NPI
Roman Kelner, M.D.
- Surgical Assistant
- Northbrook, IL
National Provider Identifier
1629423322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 238000128
- Practice address
- 792 Greenwood Rd
Northbrook, IL 60062-2629 - Phone
- (847) 736-1382
- NPI assigned
- May 1, 2016
- 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 |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 238000128 | IL | Primary |
Addresses
Primary practice location
792 Greenwood Rd
Northbrook, IL 60062-2629
Mailing address
792 Greenwood Rd
Northbrook, IL 60062-2629
Phone (847) 736-1382
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 238000128 | IL | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462060800000",
"number": "1629423322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "792 GREENWOOD RD",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600622629",
"telephone_number": "847-736-1382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "792 GREENWOOD RD",
"city": "NORTHBROOK",
"state": "IL",
"postal_code": "600622629",
"telephone_number": "847-736-1382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELNER",
"first_name": "ROMAN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-01",
"last_updated": "2016-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "IL",
"license": "238000128",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Northbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.