Individual provider Active NPI

Mark A. Nessim, M.D.

  • Anesthesiology Physician
  • Dekalb, IL
National Provider Identifier
1780840488
Registry record updated Aug 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
36.121278 Issued in IL
Practice address
1 Kish Hospital Dr.
Dekalb, IL 60115-9602
Phone
(815) 756-1521
Fax
(815) 748-8395
NPI assigned
Aug 1, 2008
Last updated
Aug 10, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 36.121278 IL Primary
Anesthesiology Physician 207L00000X 336.082541 IL

Addresses

Primary practice location

1 Kish Hospital Dr.
Dekalb, IL 60115-9602

Mailing address

1 Kish Hospital Dr.
Dekalb, IL 60115-9602
Phone (815) 756-1521

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
I20090831000496 IL Practitioner - Anesthesiology 4385799196 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Associates, LTDGroup PAC ID 2961303425, 34 clinicians

Practice addresses (Care Compare)

1 Kish Hospital Dr
Dekalb, IL 60115-9602

100 5TH St
Oswego, IL 60543-8338
Phone (630) 449-0085

1325 N Highland Ave
Aurora, IL 60506-1449
Phone (630) 859-2222

825 S Milwaukee Ave
Libertyville, IL 60048-3218
Phone (224) 504-2200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
336.082541ILMDAnesthesiology Physician
36.121278ILMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Mar 1, 2020 Accepting new patients
Valley Pain Care Centers LTD CurrentSince Jul 8, 2010 Accepting new patients
Central Dupage Physician Group CurrentSince Mar 1, 2020 Accepting new patients
Anesthesia Associates, LTD CurrentSince Jul 1, 2009 Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

1 Kish Hospital Dr
DeKalb, IL 60115
Phone (815) 754-1521

100 5th St
Oswego, IL 60543
Phone (630) 449-0085

1879 N Neltnor Blvd
West Chicago, IL 60185

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1217548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281398400000",
    "number": "1780840488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 KISH HOSPITAL DR.",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159602",
            "telephone_number": "815-756-1521",
            "fax_number": "815-748-8395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 KISH HOSPITAL DR.",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159602",
            "telephone_number": "815-756-1521",
            "fax_number": "815-748-8395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NESSIM",
        "first_name": "MARK",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-01",
        "last_updated": "2010-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "36.121278",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "336.082541",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dekalb, IL

Sources for this page

Verify at the official NPI Registry.