Active NPI
Chalermlarp Mongkolsmai, M.D.
- Pediatric Cardiology Physician
- Bloomington, IL
National Provider Identifier
1194009415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- 036059805
- Practice address
- 2206 Berrywood LN
Bloomington, IL 61704-2448 - Phone
- (309) 662-2032
- NPI assigned
- Oct 5, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | 036059805 | IL | Primary |
Addresses
Primary practice location
2206 Berrywood LN
Bloomington, IL 61704-2448
Mailing address
2206 Berrywood LN
Bloomington, IL 61704-2448
Phone (309) 662-2032
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036059805 | IL | MD | Pediatric Cardiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317772800000",
"number": "1194009415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2206 BERRYWOOD LN",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617042448",
"telephone_number": "309-662-2032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2206 BERRYWOOD LN",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617042448",
"telephone_number": "309-662-2032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONGKOLSMAI",
"first_name": "CHALERMLARP",
"name_prefix": "Mrs.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-05",
"last_updated": "2011-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "IL",
"license": "036059805",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.