NPIMap

Individual provider Active NPI

Liana Borisovna Nisimova, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1992159313
Registry record updated Sep 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036152905 Issued in IL
Practice address
259 E Erie St Ste 2150
Chicago, IL 60611-3370
Phone
(312) 926-3627
Fax
(312) 926-3858
NPI assigned
Apr 21, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036152905 IL Primary

Addresses

Primary practice location

259 E Erie St Ste 2150
Chicago, IL 60611-3370

Mailing address

259 E Erie St Ste 2150
Chicago, IL 60611-3370
Phone (312) 926-3627

Other practice location 1

1 Gustave L Levy Pl
Box 1118
New York, NY 10029-6504
Phone (212) 241-8170

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
I20200909001985 IL Practitioner - Internal Medicine 6901150499 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
JS Weill Medical College, Cornell University, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

259 E Erie St
Suite 2250
Chicago, IL 60611-3264
Phone (312) 926-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Aug 1, 2020 Accepting new patients
Foot & Ankle Center of Illinois PC CurrentSince Aug 1, 2020 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Aug 1, 2020 Accepting new patients
Central Dupage Physician Group Internal Medicine Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

Carol Stream, IL 60122
Phone (630) 933-3300

259 E Erie St
Ste 2150
Chicago, IL 60611
Phone (312) 926-5111

259 E Erie St
Ste 2250
Chicago, IL 60611
Phone (312) 695-8106

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

2921 Montvale Dr
Springfield, IL 62704
Phone (217) 787-2700

Organizations & group practices 4

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": "1461196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600992000000",
    "number": "1992159313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "259 E ERIE ST STE 2150",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113370",
            "telephone_number": "312-926-3627",
            "fax_number": "312-926-3858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 E ERIE ST STE 2150",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113370",
            "telephone_number": "312-926-3627",
            "fax_number": "312-926-3858"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Gustave L Levy Pl",
            "address_2": "Box 1118",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100296504",
            "country_code": "US",
            "telephone_number": "212-241-8170",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NISIMOVA",
        "first_name": "LIANA",
        "middle_name": "BORISOVNA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-21",
        "last_updated": "2020-09-25",
        "certification_date": "2020-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036152905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.