Jacob Kalliath, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

12506386 Issued in IL

Practice address

20201 Crawford Ave
Olympia Fields, IL 60461

Phone

(708) 679-2160

Fax

(708) 679-2161

NPI assigned

Jul 2, 2013

Last updated

Oct 30, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, WI, WA, AZ4 enrollments

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 4

Specialty

Internal Medicine

Education

Nova Southeastern College of Osteo Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chelan County Public Hospital District No 2Group PAC ID 9133027360, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lake Chelan Community Hospital Hospital, Chelan, WA, CCN 501334
• Lake Chelan Community Hospital Nursing home, CCN 50Z334

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jkalliath@yourcarecommunity.org

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.

• Chelan County Public Hospital District No 2

  dba Lake Chelan Community Hospital

  • Critical Access Hospital
  • Chelan, WA
  • NPI 1578568853
  Medicare reassignment Care Compare group NPD
• Light Matter Solutions LLC

  • Internal Medicine Physician
  • Richland Center, WI
  • NPI 1457816332
  Medicare reassignment Authorized official
• Swedish Covenant Management Services, Inc.

  dba Swedish Covenant Medical Group

  • Obstetrics & Gynecology Physician
  • Chicago, IL
  • NPI 1760432348

  Internal Medicine

  Medicare reassignment NPD
• La Paz Regional Hospital Inc

  • Critical Access Hospital
  • Parker, AZ
  • NPI 1053684555
  Medicare reassignment NPD
• Rural Physicians Group-Pannu PLLC

  • Hospitalist Physician
  • Greenwood Village, CO
  • NPI 1891236584

  WI

  Medicare reassignment
• Swedish Covenant Management Services, Inc

  dba Swedish Emergency Medicine

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1962049551
  NPD
• Chelan County Public Hospital District No 2

  dba Express Care Clinic Lake Chelan Health

  • Rural Health Clinic/Center
  • Chelan, WA
  • NPI 1124438312
  NPD
• La Paz Regional Hospital Inc

  • Urgent Care Clinic/Center
  • Parker, AZ
  • NPI 1598009029
  NPD
• La Paz Regional Hospital, Inc.

  dba Bouse Medical Clinic

  • Clinic/Center
  • Bouse, AZ
  • NPI 1235154147
  NPD
• Olympia Fields Eyecare, LTD.

  • Ophthalmology Physician
  • Flossmoor, IL
  • NPI 1598762007
  NPD (past)
• S Pannu Inc

  • Internal Medicine Physician
  • Susanville, CA
  • NPI 1407987522
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Chelan County Public Hospital District No 2

  dba Lake Chelan Community Hospital

  • Critical Access Hospital
  • Chelan, WA
  • NPI 1578568853
  Care Compare affiliation
• Chelan County Public Hospital District No. 2

  dba Lake Chelan Hospital Swing Bed

  • Medicare Defined Swing Bed Hospital Unit
  • Chelan, WA
  • NPI 1215040555

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1372723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1134569395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10624 S. EASTERN AVE #263A",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "89052",
            "telephone_number": "760-684-0407",
            "fax_number": "800-604-6214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20201 CRAWFORD AVE",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "60461",
            "telephone_number": "708-679-2160",
            "fax_number": "708-679-2161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4455 Edison Lakes Pkwy",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465451442",
            "country_code": "US",
            "telephone_number": "574-231-6134",
            "fax_number": "574-231-6845",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KALLIATH",
        "first_name": "JACOB",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-02",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "DR0057617",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "02005206A",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "12506386",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "IL",
            "license": "036138730",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jkalliath277005@direct.northshore.org",
            "affiliation": "N",
            "address_1": "20201 Crawford Ave",
            "city": "Olympia Fields",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60461",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Monique Deneen Jones, M.D.
• Nimish Joshi
• Sanjeev V Joshi, M.D.
• Alexander Kadah, MD
• Mustafa Hunaid Kagalwalla, MD
• Matthew L Kamin, DO
• Rajanikanth Kandula, MD
• Tejasvini Kapa, DO
• Carl A. Kaplan, M.D.
• Kapmarski, LLC (Olympia Fields Dental Care)

• Internal Medicine Physician in Olympia Fields, IL
• Providers in Olympia Fields, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.