Jeevan Chechakunnil Abraham, MD
Individual provider Active NPI Sports Medicine (Family Medicine) Physician · Gurnee, IL
NPI 1285097113 · NPPES record last updated Nov 13, 2024
Key facts
- NPI
- 1285097113
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Family Medicine) Physician 207QS0010X
- License
- 036148437 (IL)
- Practice address
- 6155 Grand Ave Ste 200
Gurnee, IL 60031-1651 - Phone
- (847) 535-7157
- Fax
- (224) 271-3202
- NPI assigned
- Mar 29, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Sports Medicine
- Education
- University of South Carolina School of Medicine, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Northwestern Medical Faculty Foundation
Practice addresses (Care Compare)
25 Tower CT
Suite B
Gurnee, IL 60031-3318
Phone (847) 535-7157
Hospital & facility affiliations
- Northwestern Lake Forest Hospital
- Northwestern Medicine Central Dupage Hospital
- Northwestern Medicine McHenry
- Vista Medical Center East
- Northwestern Memorial Hospital
- Shirley Ryan Abilitylab
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.19 of 100
- Quality
- 83.05
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.69 of 100
- Quality
- 82.35
- Promoting interoperability
- 98
- Improvement activities
- 40
- Cost
- 74.95
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200819003006 | IL | Practitioner - Sports Medicine |
6002101797 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036.148437 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwestern Medical Faculty Foundation | Current |
Accepting new patients | |
| Northwestern Medical Faculty Foundation | Current |
Accepting new patients | |
| Central Dupage Physician Group | Family Medicine | Past | Accepting new patients |
Locations
Carol Stream, IL 60122
Phone (630) 933-3300
Dept 5777
Carol Stream, IL 60122
1475 E Belvidere Rd
Unit 385
Grayslake, IL 60030
Phone (312) 694-0484
25 Tower Ct
Ste B
Gurnee, IL 60031
Phone (224) 271-3200
6155 Grand Ave
Ste 200
Gurnee, IL 60031
6155 Grand Ave
Ste 100
Gurnee, IL 60031
Phone (224) 271-6700
1000 N Westmoreland Rd
#3
Lake Forest, IL 60045
Phone (847) 535-8500
660 N Westmoreland Rd
#302
Lake Forest, IL 60045
1000 N Westmoreland Rd
Lake Forest, IL 60045
Phone (847) 535-6150
515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036.148437 | IL | |
| Sports Medicine (Family Medicine) Physician | 207QS0010X | 036148437 | IL | Yes |
Addresses
Primary practice location
6155 Grand Ave Ste 200
Gurnee, IL 60031-1651
Mailing address
6155 Grand Ave Ste 200
Gurnee, IL 60031-1651
Phone (847) 535-7157
Other providers in Gurnee, IL
- Cynthia Yvonne Abban
- Russul Abbas
- Jamil Abdur-Rahman
- Linda Obeng Aboagye
- Soha Omar Bauomy Abotaleb
- Elina Abugov
- Abundance Care and Wellness, LLC
- Accelerated Rehabilitation Center of Kenosha LTD
- Accelerated Rehabilitation Centers of Kenosha LTD
- Accu-Vision Center Inc.
All providers in Gurnee, IL · Sports Medicine (Family Medicine) Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.