Individual provider Active NPI

Nisreen Islaih, MD

  • Surgery Physician
  • Urbana, IL
National Provider Identifier
1669210613
Registry record updated Jun 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
125.086705 Issued in IL
Practice address
611 W Park St
Urbana, IL 61801-2501
Phone
(217) 383-3311
NPI assigned
Jul 15, 2024
Last updated
Jun 23, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgery Physician 208600000X 125.086705 IL Primary

Addresses

Primary practice location

611 W Park St
Urbana, IL 61801-2501

Mailing address

611 W Park St
Urbana, IL 61801-2501

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250703000892 IL Order and Referring Only - General SurgeryPractitioner - General Surgery 7517470354

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
125.086705ILMDSurgery Physician

Interoperability endpoints

  • Direct secure messaging: nislaihmd445000@carlehiedirect.net

NPI Registry JSON

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

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750636800000",
    "number": "1669210613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012501",
            "telephone_number": "217-383-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISLAIH",
        "first_name": "NISREEN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-15",
        "last_updated": "2025-06-23",
        "certification_date": "2025-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125.086705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

Verify at the official NPI Registry.