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NPISignal

Individual Healthcare Provider

Kenneth Richard Nissim, M.D.

NPI Record: ActiveOtolaryngology — Plastic Surgery within the Head & Neck
NPI1447246392
Rockford, Illinois

Provider's NPPES record last updated: December 11, 2024

Overview

Entity Type
Individual Healthcare Provider
NPI
1447246392
Primary Specialty
Otolaryngology — Plastic Surgery within the Head & Neck
Practice Location
Rockford, Illinois
Sole Proprietor
No

Federal Screening

NPISignal checked this NPI against federal exclusion sources. Results below are based on the NPI number itself — an identifier match, not a name match.

List of Excluded Individuals/Entities (LEIE)

HHS Office of Inspector General

No potential match identified

No potential match was identified in NPISignal's indexed List of Excluded Individuals/Entities (LEIE) records as of 2026-09-10.

Source data
September 10, 2026
Records indexed
84,001
Screened
Sep 19, 2026, 9:30 PM UTC

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

SAM.gov Exclusions

U.S. General Services Administration

Not checked

SAM.gov Exclusions was not checked.

SAM.gov screening is not configured on this deployment. No SAM check has been performed.

Screened
Not checked

This is an NPI-based check only. NPISignal does not publish name-based exclusion matches on a provider profile. A shared or similar name is a lead that requires human review, not an identification, and this page is not the place to make one. Run a name-based screening below to see potential matches with the reasons for each.

This reflects only the records NPISignal currently holds and the identity information supplied. It is not a verification of eligibility, licensure, or compliance. Verify decisions that matter against the authoritative source.

Run a name-based screening

Searches OIG LEIE and SAM.gov by name and reviews every potential match.

Specialties & Taxonomies

  • Otolaryngology

    Plastic Surgery within the Head & Neck

    Allopathic & Osteopathic Physicians

    Primary

    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.

    Taxonomy code 207YX0007X
  • Otolaryngology

    Sleep Medicine

    Allopathic & Osteopathic Physicians

    An Otolaryngologist who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders. Sleep specialists treat patients of any age and use multidisciplinary approaches. Disorders managed by sleep specialists include, but are not limited to, sleep related breathing disorders, insomnia, hypersomnias, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders.

    Taxonomy code 207YS0012X
  • Otolaryngology

    Allopathic & Osteopathic Physicians

    An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.

    Taxonomy code 207Y00000X

Provider-Reported License Information

Otolaryngology (Illinois)
036170811
Otolaryngology (Florida)
ME85561
Otolaryngology (Florida)
ME85561
License numbers are reported by the provider to NPPES and are not independently verified by NPISignal against any state licensing board. Confirm current license status directly with the issuing state board.

Practice Locations

Practice Location

1253 N Alpine Rd

Rockford, Illinois 61107-2201

Phone: (779) 696-9201

Additional Practice Location

8932 Sw 97th Ave

Miami, Florida 33176-1936

Phone: (305) 270-3740

Record Information

Enumeration Date
September 26, 2005
Provider's NPPES Record Last Updated
December 11, 2024
Certification Date
December 11, 2024
NPISignal NPPES Dataset
August 2026

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