NPIMap

Individual provider Active NPI

Asad Kizilbash, M.D

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1861630907
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
01072237A Issued in IN
Practice address
4646 N Marine Dr
Medical Education Dept
Chicago, IL 60640-5759
Phone
(773) 564-5225
NPI assigned
Jan 28, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 29446 OR
Hospitalist Physician 208M00000X 01072237A IN
Internal Medicine Physician 207R00000X 01072237A IN Primary

Addresses

Primary practice location

4646 N Marine Dr
Medical Education Dept
Chicago, IL 60640-5759

Mailing address

4300 W Lake Ave
208-B
Glenview, IL 60026-1474
Phone (847) 510-5734

Other practice location 1

1915 Lake Ave
Plymouth, IN 46563-9366
Phone (574) 948-4000

Other identifiers 1

IdentifierTypeStateIssuer
201164440MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20130809000091 IN Practitioner - Internal MedicinePractitioner - Hospitalist 1254485535 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Hospital of Bremen IncGroup PAC ID 6002897451, 5 clinicians
Galen Inpatient Physicians PCGroup PAC ID 3678464633, 1,045 clinicians

Practice addresses (Care Compare)

1020 High Rd
Bremen, IN 46506-1093
Phone (574) 546-2211

1606 N 7TH St
Vituity
Terre Haute, IN 47804-2706
Phone (812) 238-7000

1915 Lake Ave
Plymouth, IN 46563-9366
Phone (574) 948-4000

5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469
Phone (574) 335-2443

Hospital & facility affiliations

  • Saint Joseph Regional Medical Center - Plymouth Hospital, Plymouth, IN, CCN 150076
  • Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012
  • Community Hospital of Bremen Inc Hospital, Bremen, IN, CCN 151300
  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
  • Community Hospital of Bremen Inc Nursing home, CCN 15Z300

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29446ORMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Hospital of Bremen, Inc. CurrentSince Aug 1, 2020 Accepting new patients
Informe Healthcare in, LLC Internal Medicine CurrentSince Oct 1, 2022 Accepting new patients
Informe Healthcare LLC Internal Medicine CurrentSince Oct 1, 2022 Accepting new patients
Diane M. Mackie & Associates, PC Current Accepting new patients
Galen Inpatient Physicians PC Hospitalist CurrentSince Nov 1, 2024 Accepting new patients
Community Hospital of Bremen, Inc. Internal Medicine CurrentSince Aug 1, 2020 Accepting new patients
Galen Inpatient Physicians, PC Internal Medicine CurrentSince Nov 1, 2024 Accepting new patients
Saint Joseph Regional Medical Center- Plymouth Campus Inc Internal Medicine Past Accepting new patients

Locations

1020 High Rd
Bremen, IN 46506
Phone (574) 309-9967

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

745 N Swope St
Greenfield, IN 46140
Phone (317) 462-9221

8800 Virginia Pl
Merrillville, IN 46410
Phone (219) 736-1310

811 E 12th St
Mishawaka, IN 46544
Phone (574) 249-1917

1420 E Douglas Rd
Mishawaka, IN 46545
Phone (574) 307-7200

609 Tanglewood Ln
Mishawaka, IN 46545
Phone (574) 277-2500

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

1915 Lake Ave
Plymouth, IN 46563
Phone (219) 936-3181

1121 E Lasalle Ave
South Bend, IN 46617
Phone (574) 287-6501

17475 Dugdale Dr
South Bend, IN 46635
Phone (574) 247-7500

1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523

2741 W Layton Ave
Ste 106
Milwaukee, WI 53221

Interoperability endpoints

  • Direct secure messaging: akizilbash147948@direct.trinity-health.org

Organizations & group practices 19

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.

View all 19

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": "1233100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1861630907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 W LAKE AVE",
            "address_2": "208-B",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600261474",
            "telephone_number": "847-510-5734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 N MARINE DR",
            "address_2": "MEDICAL EDUCATION DEPT",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405759",
            "telephone_number": "773-564-5225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1915 Lake Ave",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "IN",
            "postal_code": "465639366",
            "country_code": "US",
            "telephone_number": "574-948-4000",
            "fax_number": "574-948-5454",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIZILBASH",
        "first_name": "ASAD",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-28",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "29446",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IN",
            "license": "01072237A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01072237A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201164440",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.