KENNETH RICHARD NISSIM (M.D.) – Plastic Surgery within the Head & Neck (Otolaryngology) Physician, NPI 1447246392
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
732 OTOLARYNGOLOGY in FL
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Provider Addresses for KENNETH RICHARD NISSIM (M.D.)
8932, Southwest 97th Avenue, Kendall, Miami-Dade County, Florida, 33176, United States
MIAMI, FL 331761936
Phone: (305) 270-3740
Type: Location
1120, Northwest 14th Street, Miami, Miami-Dade County, Florida, 33136, United States
5TH FLOOR
MIAMI, FL 331362107
Phone: (305) 243-3564
Fax: (305) 243-2009
Type: Mailing
8932 SW 97th Ave
Miami, FL 331761936
Phone: (305) 270-3740
Type: Location
1253 N ALPINE RD
ROCKFORD, IL 611072201
Phone: (779) 696-9201
Fax: (815) 397-9667
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-09-09
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20110202000263 | I | Otolaryngology | FL | TBD |
| I20240909001436 | I | Otolaryngology | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 33176)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Advanced Heart Failure And Transplant Cardiology, Cardiovascular Disease (Cardiology), Cardiovascular Disease (Cardiology), Internal Medicine | WI | |
| Thoracic Surgery, Cardiac Surgery | MI | |
| Physical Therapist In Private Practice | IL | |
| - | IL | |
| General Surgery | GA | |
| Internal Medicine | WI | |
| N E U R O S U R G E R Y | IL | |
| - | WI | |
| Orthopedic Surgery | WI | |
| Physician Assistant | WI |
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