Individual provider Active NPI

Malik Nassan, MBBS

  • Psychiatry Physician
  • Chicago, IL
National Provider Identifier
1942650130
Registry record updated Jul 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036156537 Issued in IL
Practice address
676 N Saint Clair St Ste 945
Chicago, IL 60611-2952
Phone
(312) 695-9627
Fax
(312) 695-6072
NPI assigned
Jun 17, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 27506 MN
Psychiatry Physician 2084P0800X 64359 MN
Psychiatry Physician 2084P0800X 036156537 IL Primary

Addresses

Primary practice location

676 N Saint Clair St Ste 945
Chicago, IL 60611-2952

Mailing address

676 N Saint Clair St Ste 945
Chicago, IL 60611-2952
Phone (312) 695-9627

Other practice location 1

200 1st St SW
Rochester, MN 55905
Phone (507) 284-2511

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
I20210527000344 IL Practitioner - Psychiatry 5294027256 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians
Head and Neck Cosmetic Surgery Associates LLCGroup PAC ID 2264476118, 22 clinicians

Practice addresses (Care Compare)

676 N Saint Clair
Arkes 1725
Chicago, IL 60611-2927
Phone (312) 695-8108

8930 Gross Point Rd
Suite 700
Skokie, IL 60077-1864
Phone (773) 262-4110

Hospital & facility affiliations

  • Palos Community Hospital Home Health Care Home health agency, Lemont, IL, CCN 147470
  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281
  • Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130
  • Shirley Ryan Abilitylab Inpatient rehabilitation facility, Chicago, IL, CCN 143026

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036156537ILMDPsychiatry Physician
27506MNMDPsychiatry Physician
64359MNMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jul 1, 2021 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 1, 2021 Accepting new patients
Head & Neck Cosmetic Surgery Associates LLC CurrentSince Dec 1, 2021 Accepting new patients
Central Dupage Physician Group PastSince Jul 17, 2021 Accepting new patients
Presence Healthcare Services Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

676 N Saint Clair St
Ste 1725
Chicago, IL 60611
Phone (312) 664-8533

3000 N Halsted St
Ste 400
Chicago, IL 60657
Phone (773) 296-5500

2522 W Peterson Ave
Chicago, IL 60659
Phone (773) 262-4110

676 N Saint Clair St
Ste 945
Chicago, IL 60611
Phone (312) 695-7902

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

8930 Gross Point Rd
Ste 700
Skokie, IL 60077
Phone (847) 966-8930

Organizations & group practices 5

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.

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": "1466121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1942650130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 945",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112952",
            "telephone_number": "312-695-9627",
            "fax_number": "312-695-6072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 945",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112952",
            "telephone_number": "312-695-9627",
            "fax_number": "312-695-6072"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "55905",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NASSAN",
        "first_name": "MALIK",
        "name_prefix": "Dr.",
        "credential": "MBBS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-17",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "27506",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "64359",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036156537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.