Kevin K Chacko, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

T2840 Issued in TX

Practice address

4649 Seabiscuit St
Carrollton, TX 75010-4206

Phone

(214) 938-6605

NPI assigned

May 15, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kchacko171491@cookchildrens.direct-ci.com

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.

• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1750369203
  Medicare reassignment NPD
• Cook Children'S Physician Network

  • Pediatrics Physician
  • Fort Worth, TX
  • NPI 1083472062
  NPD

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

{
    "created_epoch": "1526342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1245720259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 733784",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753733784",
            "telephone_number": "682-885-6483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4649 SEABISCUIT ST",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750104206",
            "telephone_number": "214-938-6605"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 University Blvd",
            "address_purpose": "LOCATION",
            "city": "Galveston",
            "state": "TX",
            "postal_code": "775551119",
            "country_code": "US",
            "telephone_number": "409-772-3695",
            "fax_number": "409-772-3680",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4300 W University Dr Ste 10",
            "address_purpose": "LOCATION",
            "city": "Prosper",
            "state": "TX",
            "postal_code": "750789806",
            "country_code": "US",
            "telephone_number": "682-303-8050",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "KEVIN",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-15",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "BP10064499",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "T2840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kchacko171491@CookChildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "4300 W University Dr Ste 10",
            "city": "Prosper",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750789806",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Century Hospice LLC
• Century Medical Consulting & Supply LLC
• Julio Cervantes, L.P.C.
• Cesar J Aleman, MD, PA
• CFC, PLLC
• Merideth Chaffin
• Ravindra Chandrashekhar, M.D.
• Yong D Chang, MD
• Yoon Chang, D.D.S., M.S.
• Lucy Chipoya Changwe, PMHNP

• Pediatrics Physician in Carrollton, TX
• Providers in Carrollton, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2021; 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.