Individual provider Active NPI

Jacqueline B Corboy, MD

  • Pediatric Emergency Medicine (Emergency Medicine) Physician
  • Chicago, IL
National Provider Identifier
1174587059
Registry record updated May 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Emergency Medicine) PhysicianTaxonomy code 207PP0204X
License
036121643 Issued in IL
Practice address
225 E Chicago Ave # 62
Chicago, IL 60611-2991
Phone
(800) 543-7362
Fax
(312) 227-9475
NPI assigned
Apr 17, 2006
Last updated
May 22, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2020

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 036121643 IL
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X 036121643 IL Primary

Addresses

Primary practice location

225 E Chicago Ave # 62
Chicago, IL 60611-2991

Mailing address

225 E Chicago Ave # 62
Chicago, IL 60611-2991
Phone (800) 543-7362

Other identifiers 1

IdentifierTypeStateIssuer
036121643MedicaidIL

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090810000090 IL Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 8224108212 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Pediatric Medicine
Education
Rutgers New Jersey Medical School, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lurie Children's Medical Group Inc.Group PAC ID 4789597279, 142 clinicians

Practice addresses (Care Compare)

880 W Central Rd
Arlington Heights, IL 60005-2355
Phone (800) 543-7362

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036121643ILMDPediatric Emergency Medicine (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jan 18, 2021 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jan 18, 2021 Accepting new patients
Lurie Children's Medical Group Inc Pediatrics CurrentSince Oct 6, 2016 Accepting new patients

Locations

880 W Central Rd
Arlington Hts, IL 60005
Phone (847) 483-9400

Carol Stream, IL 60122
Phone (630) 933-3300

Claims Remittance
Carol Stream, IL 60122

Dept 5777
Carol Stream, IL 60122

225 E Chicago Ave
Chicago, IL 60611
Phone (312) 227-6415

225 E Chicago Ave
#62
Chicago, IL 60611
Phone (312) 227-6080

737 N Michigan Ave
Ste 2040
Chicago, IL 60611

1 Kish Hospital Dr
DeKalb, IL 60115
Phone (815) 754-1521

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

25 N Winfield Rd
Winfield, IL 60190
Phone (630) 682-1600

Organizations & group practices 3

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": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590105600000",
    "number": "1174587059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 E CHICAGO AVE # 62",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112991",
            "telephone_number": "800-543-7362",
            "fax_number": "312-227-9475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E CHICAGO AVE # 62",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112991",
            "telephone_number": "800-543-7362",
            "fax_number": "312-227-9475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORBOY",
        "first_name": "JACQUELINE",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-17",
        "last_updated": "2020-05-22",
        "certification_date": "2020-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036121643",
            "primary": false
        },
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "IL",
            "license": "036121643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036121643",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.