Lisa Renee Chacko, M.D., MPH

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME128039 Issued in FL

Practice address

1707 N Main St
Gainesville, FL 32609-3650

Phone

(352) 265-9593

NPI assigned

Jun 6, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lisa.chacko@419737856901124.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 and National Provider Directory roles.

• Florida Clinical Practice Association Inc

  • Surgery Physician
  • Gainesville, FL
  • NPI 1063463768

  Family Medicine

  Medicare reassignment NPD
• Trenton Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Trenton, FL
  • NPI 1801826268
  Medicare reassignment NPD
• Florida Clinical Practice Association Inc

  • Durable Medical Equipment & Medical Supplies
  • Ocala, FL
  • NPI 1609529478
  NPD
• Trenton Medical Center Inc

  • Federally Qualified Health Center (FQHC)
  • Gainesville, FL
  • NPI 1740513928
  NPD
• Trenton Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fleming Island, FL
  • NPI 1275220238
  NPD

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

{
    "created_epoch": "1370476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1104264654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SW ARCHER RD",
            "address_2": "BOX 100383",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326100383",
            "telephone_number": "352-392-4541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 N MAIN ST",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326093650",
            "telephone_number": "352-265-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "LISA",
        "middle_name": "RENEE",
        "credential": "M.D., MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-06",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME128039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018346000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriel Rene Cerra
• Alexander Cespedes, PTA
• Matthew James Cetlinski
• Jose Cevallos
• Seunghee Cha, D.D.S.
• Christina Baldwin Chadwick, M.D.
• Samuel Chadwick
• Shelby Chadwick
• Joanna Chaffin
• Fatima Chagani

• Family Medicine Physician in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.