Justin Chacko, D.O.
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Plainview, NY
NPI 1013363233 · NPPES record last updated May 5, 2016
Key facts
- NPI
- 1013363233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- License
- 174003653 (NY)
- Practice address
- 888 Old Country Rd
Plainview, NY 11803-4914 - Phone
- (516) 719-3000
- NPI assigned
- May 5, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Hospitalist
- Education
- New York College of Osteo Medicine of New York Institute of Technology, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- North Shore-Lij Medical PC
Practice addresses (Care Compare)
221 Jericho Tpke
Syosset, NY 11791-4515
Phone (516) 496-2752
Hospital & facility affiliations
- Plainview Hospital
- North Shore University Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.07 of 100
- Quality
- 79.77
- Promoting interoperability
- 88.77
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191008001447 | NY | Practitioner - Hospitalist |
2567706732 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 174003653 | NY | MD | Student in an Organized Health Care Education/Training Program |
Practice roles (2 of 6)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Shore-Lij Medical PC | Current |
Accepting new patients | |
| Plainview Hospital | Past | Accepting new patients |
Locations
888 Old Country Rd
Plainview, NY 11803
Phone (516) 719-2543
300 Community Dr
Plandome, NY 11030
221 Jericho Tpke
Syosset, NY 11791
Phone (516) 496-6400
972 Brush Hollow Rd
Westbury, NY 11590
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
Interoperability endpoints
- jchacko66067@northwell.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 174003653 | NY | Yes |
Addresses
Primary practice location
888 Old Country Rd
Plainview, NY 11803-4914
Mailing address
1733 Bard LN
East Meadow, NY 11554-1502
Phone (516) 547-0474
Other providers in Plainview, NY
- Central Nassau Guidance & Counseling Services, Inc.
- Nicholas Centrowitz
- Annette Elizabeth Cepero-Jimenez
- Amanda Cerisano
- Alexandra Cerone
- Chanchal K. Saha MD PC
- Naomi Bridgette Emilia Chandler-Ofuya
- Julie Chandy
- Jeffrey M Chanin
- Matthew Ryan Chapman
All providers in Plainview, NY · Student in an Organized Health Care Education/Training Program in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.