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KENNETH RICHARD NISSIM M.D.
NPI 1447246392
Otolaryngology - Plastic Surgery within the Head & Neck in Rockford, IL

Active since September 26, 2005PECOS EnrolledAccepts Medicare Assignment
80.11/100
CMS Quality Rating
1253 N ALPINE RD, ROCKFORD, IL 61107(779) 696-9201(815) 397-9667 Get Directions Write a Review

NPPES record last updated: December 11, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Kenneth Richard Nissim M.d. NPPES

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

KENNETH RICHARD NISSIM M.D. (NPI 1447246392) is an individual plastic surgery within the head & neck provider in Rockford, Illinois, licensed in Illinois (036170811) and active in the NPI registry since September 2005. He is enrolled in Medicare PECOS, is affiliated with Marion Communtiy Hospital, and maintains a secondary practice location in Miami.

NPPES Registry Identity

NPI1447246392
Entity TypeIndividualMale
Primary Taxonomy207YX0007X
Provider Legal NameKENNETH RICHARD NISSIMCredential: M.D.
Location Address1253 N ALPINE RDRockford, IL 61107-2201
Mailing Address1120 Nw 14th St, 5th FloorMiami, FL 33136-2107 · (305) 243-3564 · Fax (305) 243-2009
Phone(779) 696-9201
Fax(815) 397-9667
Sole ProprietorNo
Medical School CMSHarvard Medical SchoolGraduated 1990
Enumeration DateSeptember 26, 2005
Last NPPES UpdateDecember 11, 2024
NPPES CertifiedDecember 11, 2024
✔ NPI 1447246392 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyOtolaryngology · Plastic Surgery within the Head & NeckAllopathic & Osteopathic Physicians
Taxonomy Code207YX0007X
License✔ Licensed in IL · 036170811
Definition
An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.
Also ListedOtolaryngologyTaxonomy 207Y00000X · License ME85561 (FL)
Also ListedOtolaryngology · Sleep MedicineTaxonomy 207YS0012X · License ME85561 (FL)
1253 N ALPINE RD, Rockford, IL 61107
Open in Google Maps ↗

Secondary Practice Location 1

Location 18932 SW 97th AveMiami, FL 33176-1936 · Phone (305) 270-3740

Other Identifiers 1

Medicaid2675617-00FL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Superior HealthPlan, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kenneth Richard Nissim M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2668652082
PECOS Enrollment IDI20110202000263
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

3

Medicare enrollment records show Kenneth Nissim reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Swedishamerican Hospital
Same address
Endocrinology, Diabetes & Metabolism
1253 N ALPINE RD
Rockford, IL 61107
  • Reassigned Medicare billing, Illinois enrollment
  • 474 clinicians in this Medicare group
NPI 1144382268 (779) 696-9201
Lakeland Regional Health Systems, Inc.
1,058 mi
Multi-Specialty
1324 LAKELAND HILLS BLVD, FINANCE DEPARTMENT
Lakeland, FL 33805
  • Reassigned Medicare billing, Florida enrollment
  • 740 clinicians in this Medicare group
NPI 1497748743 (863) 687-7251
University Of Miami
1,178 mi
Ambulatory Surgical
7103 FAIRWAY DR
Palm Beach Gardens, FL 33418
  • Reassigned Medicare billing, Florida enrollment
  • 3,639 clinicians in this Medicare group
NPI 1346317039 (561) 515-1500

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

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203
This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.
13 services13 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Marion Communtiy Hospital

Acute Care Hospitals · Ocala, FL
1/5 CMS rating
OwnershipProprietary
CMS Certification Number100212
Location1431 SW 1st AveOcala, FL 34471 · Marion County
Emergency services

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

80.11/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality63.29
Promoting Interoperability97
Improvement Activities40
Cost64.85

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. AMRUTHA MARY GEORGE M.D.
Internal Medicine (Endocrinology, Diabetes & Metabolism)
1253 N ALPINE RD
ROCKFORD, IL 61107
Winnebago County (779) 696-9201
JESSICA E MUCCIANTI PA C
Physician Assistant
1253 N ALPINE RD
ROCKFORD, IL 61107
Winnebago County (779) 696-9201
SWEDISHAMERICAN HOSPITAL
Internal Medicine (Endocrinology, Diabetes & Metabolism)
1253 N ALPINE RD
ROCKFORD, IL 61107
Winnebago County (779) 696-9201
MICHAELA FRITZ
Nurse Practitioner (Family)
1253 N ALPINE RD
ROCKFORD, IL 61107
Winnebago County (779) 696-9201
MS. ANN L. BROUGHTON M.A.
Audiologist
1253 N ALPINE RD
ROCKFORD, IL 61107
Winnebago County (779) 696-9201
SUSAN A MARSHALL AUD
Audiologist
1253 N ALPINE RD
ROCKFORD, IL 61107
Winnebago County (779) 696-9201
SANJAY PRASAD M.D.
Otolaryngology
1253 N ALPINE RD
ROCKFORD, IL 61107
Winnebago County (779) 696-9201
MARK L. LUNDINE
Otolaryngology
1253 N ALPINE RD
ROCKFORD, IL 61107
Winnebago County (779) 696-9201

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 Kenneth Nissim's NPI number?

The NPI number for Kenneth Nissim is 1447246392. It was assigned to this individual provider in the NPPES registry on September 26, 2005.

Where is Kenneth Nissim located?

Kenneth Nissim practices at 1253 N Alpine Rd, Rockford, IL 61107. The listed phone number is (779) 696-9201.

What is Kenneth Nissim's specialty?

The primary specialty registered for this NPI is Otolaryngology, specializing in Plastic Surgery within the Head & Neck, with taxonomy code 207YX0007X.

Is Kenneth Nissim enrolled in Medicare?

Yes. Kenneth Nissim is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Kenneth Nissim's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kenneth Nissim reassigns Medicare benefits to 3 organizations: Swedishamerican Hospital (Rockford, IL), Lakeland Regional Health Systems, Inc. (Lakeland, FL) and University Of Miami (Palm Beach Gardens, FL). 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 Kenneth Nissim's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kenneth Nissim accept?

Health plans from Ambetter Health, Ambetter from Superior HealthPlan, Ambetter of Alabama, Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) and 1 other insurer list Kenneth Nissim as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Kenneth Nissim affiliated with any hospitals?

According to CMS data, Kenneth Nissim is affiliated with Marion Communtiy Hospital.

When was this NPI record last updated?

The NPPES record for Kenneth Nissim was last updated on December 11, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 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.