NPIMap

Individual provider Active NPI

Jack R Chamberlin, M.D.

  • Interventional Cardiology Physician
  • Elk Grove Village, IL
National Provider Identifier
1215980321
Registry record updated Apr 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
036-086925 Issued in IL
Practice address
800 Biesterfield Rd Ste G01
Wimmer Building
Elk Grove Village, IL 60007-3372
Phone
(847) 981-3680
Fax
(847) 956-5122
NPI assigned
May 18, 2006
Last updated
Apr 10, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036086925 IL
Interventional Cardiology Physician 207RI0011X 036-086925 IL Primary

Addresses

Primary practice location

800 Biesterfield Rd Ste G01
Wimmer Building
Elk Grove Village, IL 60007-3372

Mailing address

900 S Frontage Rd
Suite 325
Woodridge, IL 60517-4903
Phone (847) 981-3680

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050408000764 IL Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 4385626340 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
University of Nebraska College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alexian Brothers Specialty GroupGroup PAC ID 0840465084, 45 clinicians

Practice addresses (Care Compare)

800 Biesterfield Rd
Elk Grove Village, IL 60007-3372
Phone (847) 981-3680

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting50
Varicose vein removal26
Leg revascularization (restoring blood flow)86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-086925ILMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bonaventure Medical Foundation, LLC CurrentSince May 14, 2012 Accepting new patients
Alexian Brothers Specialty Group CurrentSince Nov 1, 2011 Accepting new patients
Cardiovascular Associates, S.C. Cardiovascular Disease Current Accepting new patients
Heart Care Centers of Illinois, SC Cardiovascular Disease Past Accepting new patients
Uropartners, LLC Past Accepting new patients

Locations

25883 Network Pl
Chicago, IL 60673

701 Biesterfield Rd
Elk Grove Vlg, IL 60007
Phone (847) 228-0460

800 Biesterfield Rd
Ste G01
Elk Grove Vlg, IL 60007

955 Beisner Rd
Elk Grove Vlg, IL 60007
Phone (847) 640-5666

701 Winthrop Ave
Glendale Hts, IL 60139
Phone (630) 312-2000

2000 W Lake St
Hanover Park, IL 60133
Phone (224) 456-6662

1555 N Barrington Rd
Ste 4250
Hoffman Estates, IL 60169
Phone (847) 781-8600

1786 Moon Lake Blvd
Hoffman Estates, IL 60169
Phone (847) 640-5640

13300 S State Route 47
Huntley, IL 60142
Phone (847) 515-2200

1710 W Court St
Kankakee, IL 60901
Phone (815) 936-3200

190 W Irving Park Rd
Wood Dale, IL 60191
Phone (630) 766-0412

900 S Frontage Rd
Ste 325
Woodridge, IL 60517

Interoperability endpoints

  • Direct secure messaging: jack.chamberlin.p1@direct.cmi.nextgenshare.com

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428624000000",
    "number": "1215980321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 S FRONTAGE RD",
            "address_2": "SUITE 325",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605174903",
            "telephone_number": "847-981-3680",
            "fax_number": "847-956-5122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 BIESTERFIELD RD STE G01",
            "address_2": "WIMMER BUILDING",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073372",
            "telephone_number": "847-981-3680",
            "fax_number": "847-956-5122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMBERLIN",
        "first_name": "JACK",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2015-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036086925",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "036-086925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove Village, IL

Sources for this page

Verify at the official NPI Registry.