Individual provider Active NPI

Mary Katherine Bisaga, N.P.

  • Obstetrics & Gynecology Nurse Practitioner
  • Oak Lawn, IL
National Provider Identifier
1891856324
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
Practice address
4700 W 95TH St
Suite 303
Oak Lawn, IL 60453-2533
Phone
(708) 857-7230
Fax
(708) 425-5779
NPI assigned
Dec 12, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X IL Primary

Addresses

Primary practice location

4700 W 95TH St
Suite 303
Oak Lawn, IL 60453-2533

Mailing address

4700 W 95TH St
Oak Lawn, IL 60453-2533
Phone (708) 857-7230

Other identifiers 2

IdentifierTypeStateIssuer
0091640661OtherILBCBS
0091640664OtherILBCBSIL

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080804000396 IL Practitioner - Nurse Practitioner 7618041047 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
209-005834ILMDObstetrics & Gynecology Nurse Practitioner

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1891856324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532533",
            "telephone_number": "708-857-7230",
            "fax_number": "708-425-5779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 W 95TH ST",
            "address_2": "SUITE 303",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532533",
            "telephone_number": "708-857-7230",
            "fax_number": "708-425-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISAGA",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0091640661",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL",
            "identifier": "0091640664",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

Verify at the official NPI Registry.