NPIMap

Individual provider Active NPI

Nathan Tseboh Chomilo, M.D.

  • Pediatrics Physician
  • Brooklyn Center, MN
National Provider Identifier
1063656593
Registry record updated Aug 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
53869 Issued in MN
Practice address
6000 Earle Brown Dr
Pediatrics
Brooklyn Center, MN 55430-2506
Phone
(952) 993-4909
NPI assigned
Apr 28, 2009
Last updated
Aug 6, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 53869 MN Primary
Hospitalist Physician 208M00000X 53689 MN

Addresses

Primary practice location

6000 Earle Brown Dr
Pediatrics
Brooklyn Center, MN 55430-2506

Mailing address

6000 Earle Brown Dr
Pediatrics
Brooklyn Center, MN 55430-2506
Phone (952) 993-4909

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111221000566 MN Practitioner - Pediatric MedicinePractitioner - Family PracticePractitioner - Internal Medicine 1456527456 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
53869MNMDPediatrics Physician
53689MNMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Health Services Current Accepting new patients
Park Nicollet Clinic Pediatrics CurrentSince Aug 18, 2014 Accepting new patients
Fairview Clinics CurrentSince Nov 29, 2011 Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Clinics CurrentSince Nov 29, 2011 Accepting new patients
Group Health, Inc. CurrentSince Jul 1, 2013 Accepting new patients
Fairview Health Services CurrentSince Nov 29, 2011 Accepting new patients
Group Health, Inc. Current Accepting new patients
Park Nicollet Clinic Pediatrics CurrentSince Aug 18, 2014 Accepting new patients
Group Health, Inc. CurrentSince Jul 1, 2013 Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

6000 Earle Brown Dr
Minneapolis, MN 55430
Phone (952) 993-4800

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

Interoperability endpoints

  • Direct secure messaging: nchomilo42723@direct.healthpartners.com

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1240876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470441600000",
    "number": "1063656593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 EARLE BROWN DR",
            "address_2": "PEDIATRICS",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302506",
            "telephone_number": "952-993-4909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 EARLE BROWN DR",
            "address_2": "PEDIATRICS",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554302506",
            "telephone_number": "952-993-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOMILO",
        "first_name": "NATHAN",
        "middle_name": "TSEBOH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-28",
        "last_updated": "2016-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "53869",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MN",
            "license": "53689",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Center, MN

Sources for this page

Verify at the official NPI Registry.