Individual provider Active NPI

Mark Levine

  • Registered Dietitian
  • Chicago, IL
National Provider Identifier
1831578202
Registry record updated May 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
164006471 Issued in IL
Practice address
444 W Jackson Blvd
Chicago, IL 60606-6923
Phone
(312) 627-0444
NPI assigned
May 19, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 164006471 IL Primary

Addresses

Primary practice location

444 W Jackson Blvd
Chicago, IL 60606-6923

Mailing address

444 W Jackson Blvd
Chicago, IL 60606-6923
Phone (312) 627-0444

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
164006471ILMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Brooke Kayman Fox, Inc. CurrentSince Oct 7, 2019 Accepting new patients
Fay Nutrition Dietitian, Registered Past Accepting new patients

Locations

950 Skokie Blvd
Ste 305
Northbrook, IL 60062
Phone (773) 392-4667

Organizations & group practices 2

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": "1431993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431993600000",
    "number": "1831578202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 W JACKSON BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606066923",
            "telephone_number": "312-627-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 W JACKSON BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606066923",
            "telephone_number": "312-627-0444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEVINE",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-19",
        "last_updated": "2015-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164006471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.