Jerry M Mutua, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036062092 Issued in IL

Practice address

326 W 64TH St
St. Bernards Hospital
Chicago, IL 60621-3114

Phone

(773) 994-5502

Fax

(773) 994-7405

NPI assigned

Apr 5, 2006

Sex

Male

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 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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmutua@direct-address.org

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.

• Foundation for Emergency Services

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1467468280
  Medicare reassignment NPD
• Foundation for Emergency Services

  • Primary Care Clinic/Center
  • Chicago, IL
  • NPI 1992053029
  NPD

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235520000000",
    "number": "1184686149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 S EUCLID AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606491510",
            "telephone_number": "773-994-5502",
            "fax_number": "773-994-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "326 W 64TH ST",
            "address_2": "ST. BERNARDS HOSPITAL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606213114",
            "telephone_number": "773-994-5502",
            "fax_number": "773-994-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTUA",
        "first_name": "JERRY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2009-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036062092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "207Q0000X",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036062092",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Petham Muthuswamy, M.D.
• Ece Mutlu, M.D.
• Gokhan Mutlu
• Hemant Raj Mutneja, M.D.
• Saad Muttar, MD
• Mwia Mutua, M.D.
• Mutual Healthcare Inc
• Issa Mutyaba
• Nitesh Mutyala, MBBS
• Claire Muwele, PHD

• Family Medicine Physician in Chicago, IL
• Providers in Chicago, 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 Feb 25, 2009; 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.