Jerry Idiculla Chandy, N.P.

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

4704276954 Issued in MI

Practice address

1675 Kingsway CT Ste 1
Trenton, MI 48183-1958

Phone

(734) 676-8530

NPI assigned

Nov 5, 2013

Last updated

Mar 7, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jchandy13945@direct.hfhs.org
• Direct secure messaging: jerry.chandy@450368864321540.direct.elationemr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Downriver Specialists, P.C.

  • Internal Medicine Physician
  • Brownstown TWP, MI
  • NPI 1023044542
  Medicare reassignment NPD
• Trenton Total Health Care Center PC

  • Internal Medicine Physician
  • Trenton, MI
  • NPI 1932270584
  Medicare reassignment NPD
• Kingsway Medical Pharmacy

  • Community/Retail Pharmacy
  • Trenton, MI
  • NPI 1023179843
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741305600000",
    "number": "1023447695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 KINGSWAY CT STE 1",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481831958",
            "telephone_number": "734-676-8530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1675 KINGSWAY CT STE 1",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481831958",
            "telephone_number": "734-676-8530"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "632 Broadway Ph",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100122614",
            "country_code": "US",
            "telephone_number": "800-731-4254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANDY",
        "first_name": "JERRY",
        "middle_name": "IDICULLA",
        "name_prefix": "Mr.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-05",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704276954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Kate Castle, LLMSW
• Joanna Marie Cavanaugh, RN, BSN
• Chad C Carver DDS ,PLLC (General Dentist)
• Susan B Chamberlain, MD
• Yat Hei Chan, PHARMD
• Debra Angelina Checkler, AGPC-NP
• Christina Lucas DO
• Branden Christodoulos, DO
• Felicia M Christopher
• Katherine VI Chuong, PHARMD

• Adult Health Nurse Practitioner in Trenton, MI
• Providers in Trenton, MI by specialty
• Adult Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.