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NISSIM STOLBERG D.O
NPI 1124412416
Pediatrics - Pediatric Rheumatology in Chicago, IL

Active since March 24, 2015PECOS Enrolled
2652 W GREENLEAF AVE, APT #2, CHICAGO, IL 60645(773) 701-2085 Get Directions Write a Review

NPPES record last updated: March 21, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 21, 2025, Nov 8, 2021 (2 updates tracked since 2021).

About Nissim Stolberg D.o NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NISSIM STOLBERG D.O (NPI 1124412416) is an individual pediatric rheumatology provider in Chicago, Illinois, licensed in Illinois (036157013) and active in the NPI registry since March 2015. He is enrolled in Medicare PECOS and maintains a secondary practice location in Chicago.

NPPES Registry Identity

NPI1124412416
Entity TypeIndividualMale
Primary Taxonomy2080P0216X
Provider Legal NameNISSIM STOLBERGCredential: D.O
Location Address2652 W GREENLEAF AVE, APT #2Chicago, IL 60645-3208
Mailing Address9332 Tripp Ave Apt 2Skokie, IL 60076-1457 · (773) 701-2085
Phone(773) 701-2085
Sole ProprietorNo
Enumeration DateMarch 24, 2015
Last NPPES UpdateMarch 21, 20252 updates tracked since enumeration
NPPES CertifiedMarch 21, 2025
✔ NPI 1124412416 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPediatrics · Pediatric RheumatologyAllopathic & Osteopathic Physicians
Taxonomy Code2080P0216X
License✔ Licensed in IL · 036157013
Definition
A pediatrician who treats diseases of joints, muscle, bones and tendons. A pediatric rheumatologist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and collagen diseases.
Also ListedPediatricsTaxonomy 208000000X · License 036157013 (IL)
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
2652 W GREENLEAF AVE, Chicago, IL 60645
Open in Google Maps ↗

Secondary Practice Location 1

Location 11740 W Taylor StChicago, IL 60612-7232 · Phone (312) 996-7416

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nissim Stolberg D.o is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Nissim Stolberg reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

The Board Of Trustees Of The University Of Illinois
4.9 mi
Primary Care
3656 N HALSTED ST
Chicago, IL 60613
  • Reassigned Medicare billing, Illinois enrollment
  • 2,127 clinicians in this Medicare group
NPI 1588815401 (734) 726-4697
Cook County
6.9 mi
Primary Care
5501 W. FULLERTON AVE
Chicago, IL 60639
  • Reassigned Medicare billing, Illinois enrollment
  • 1,047 clinicians in this Medicare group
NPI 1689794489 (312) 395-7400

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nissim Stolberg's NPI number?

The NPI number for Nissim Stolberg is 1124412416. It was assigned to this individual provider in the NPPES registry on March 24, 2015.

Where is Nissim Stolberg located?

Nissim Stolberg practices at 2652 W Greenleaf Ave Apt #2, Chicago, IL 60645. The listed phone number is (773) 701-2085.

What is Nissim Stolberg's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Rheumatology, with taxonomy code 2080P0216X.

Is Nissim Stolberg enrolled in Medicare?

Yes. Nissim Stolberg is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Nissim Stolberg's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nissim Stolberg reassigns Medicare benefits to 2 organizations: The Board Of Trustees Of The University Of Illinois (Chicago, IL) and Cook County (Chicago, IL). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nissim Stolberg's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Nissim Stolberg was last updated on March 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.