Active NPI
David Bruce Altman, MD
- Psychiatry Physician
- Skokie, IL
National Provider Identifier
1679636690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 036047157
- Practice address
- 9933 Lawler Ave Ste 444
Skokie, IL 60077-3707 - Phone
- (847) 674-2025
- Fax
- (847) 674-2073
- NPI assigned
- Dec 19, 2006
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 036047157 | IL | Primary |
Addresses
Primary practice location
9933 Lawler Ave Ste 444
Skokie, IL 60077-3707
Mailing address
9933 Lawler Ave Ste 444
Skokie, IL 60077-3707
Phone (847) 674-2025
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036047157 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 15, 2014 through May 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036047157 | IL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280793600000",
"number": "1679636690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9933 LAWLER AVE STE 444",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600773707",
"telephone_number": "847-674-2025",
"fax_number": "847-674-2073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9933 LAWLER AVE STE 444",
"city": "SKOKIE",
"state": "IL",
"postal_code": "600773707",
"telephone_number": "847-674-2025",
"fax_number": "847-674-2073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALTMAN",
"first_name": "DAVID",
"middle_name": "BRUCE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-19",
"last_updated": "2010-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "036047157",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036047157",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Skokie, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.