Active NPI
Kenneth A Noffsinger, MD
- Gynecology Physician
- St Charles, IL
National Provider Identifier
1669485017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 036048330
- Practice address
- 960 N 5TH Ave Ste E
St Charles, IL 60174-1205 - Phone
- (630) 584-8877
- Fax
- (630) 584-0265
- NPI assigned
- Aug 15, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 036048330 | IL | Primary |
Addresses
Primary practice location
960 N 5TH Ave Ste E
St Charles, IL 60174-1205
Mailing address
2320 Dean St Ste 103
St Charles, IL 60175-1068
Phone (630) 377-0106
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036048330 | Medicaid | IL |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160609002379 | IL | Order and Referring Only - Obstetrics/Gynecology | 8123008810 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036048330 | IL | MD | Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kenneth a Noffsinger MD LTD | Gynecology | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669485017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2320 DEAN ST STE 103",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601751068",
"telephone_number": "630-377-0106",
"fax_number": "630-377-1186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "960 N 5TH AVE STE E",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601741205",
"telephone_number": "630-584-8877",
"fax_number": "630-584-0265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOFFSINGER",
"first_name": "KENNETH",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "IL",
"license": "036048330",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036048330",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Charles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.