NPIMap

Individual provider Active NPI

Kristopher Michael McDonough, M.D.

  • Pulmonary Disease Physician
  • Joliet, IL
National Provider Identifier
1851412779
Registry record updated Nov 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
36113500 Issued in IL
Practice address
903 N 129TH Infantry Dr
Suite #400
Joliet, IL 60435-3171
Phone
(815) 725-2653
Fax
(815) 744-3232
NPI assigned
Apr 2, 2007
Last updated
Nov 30, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 36113500 IL Primary

Addresses

Primary practice location

903 N 129TH Infantry Dr
Suite #400
Joliet, IL 60435-3171

Mailing address

903 N 129TH Infantry Dr
Suite #400
Joliet, IL 60435-3171
Phone (815) 725-2653

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050817000396 IL Practitioner - Pulmonary DiseasePractitioner - Internal Medicine 7113957374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Internal Medicine
Education
Rush Medical College of Rush University, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Midwest Respiratory, LTD.Group PAC ID 8527034263, 18 clinicians

Practice addresses (Care Compare)

903 Infantry Dr
Suite 400
Joliet, IL 60435-5002
Phone (815) 725-2653

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36113500ILMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Respiratory, LTD. Pulmonary Disease CurrentSince Jul 1, 2009 Accepting new patients
Butterfield Health Care II, Inc. CurrentSince Jul 1, 2009 Accepting new patients
Symphony Deerbrook LLC CurrentSince Jul 1, 2009 Accepting new patients

Locations

903 N 129th Infantry Dr
Ste 400
Joliet, IL 60435
Phone (815) 725-2653

151 W High St
Morris, IL 60450
Phone (815) 416-1331

678 Cedar Crossings Dr
Ste 201
New Lenox, IL 60451
Phone (815) 740-1301

10660 W 143rd St
Orland Park, IL 60462
Phone (219) 838-0066

Organizations & group practices 3

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 8

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": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259539200000",
    "number": "1851412779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 N 129TH INFANTRY DR",
            "address_2": "SUITE #400",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604353171",
            "telephone_number": "815-725-2653",
            "fax_number": "815-744-3232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 N 129TH INFANTRY DR",
            "address_2": "SUITE #400",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604353171",
            "telephone_number": "815-725-2653",
            "fax_number": "815-744-3232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONOUGH",
        "first_name": "KRISTOPHER",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2009-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "36113500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

Verify at the official NPI Registry.