Connie D Chappel, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036071002 Issued in IL

Practice address

1515 N Harlem Ave
Suite 309
Oak Park, IL 60302-1205

Phone

(708) 386-4411

NPI assigned

Feb 21, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

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

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421712000000",
    "number": "1114062585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6370",
            "city": "RIVER FOREST",
            "state": "IL",
            "postal_code": "603056370",
            "telephone_number": "708-386-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 N HARLEM AVE",
            "address_2": "SUITE 309",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021205",
            "telephone_number": "708-386-4411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAPPEL",
        "first_name": "CONNIE",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-21",
        "last_updated": "2015-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036071002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036 071002",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "31602115",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Oak Park, IL
• Providers in Oak Park, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; 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.