Sheena Aleena Eettickal, D.O

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036147804 Issued in IL

Practice address

200 N Gary Ave
Carol Stream, IL 60188-1834

Phone

(630) 360-2958

Fax

(630) 360-2959

NPI assigned

Jun 7, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Family Practice

Education

Midwestern University, Chicago College of Osteopathic Med, 2016

Medicare assignment

May accept Medicare assignment

Group practices

Suburban Medical Group CorpGroup PAC ID 3476967399, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Suburban Medical Group Corp

  • Urgent Care Clinic/Center
  • Bolingbrook, IL
  • NPI 1871180901

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Suburban Medical Group Corp

  • Urgent Care Clinic/Center
  • Carol Stream, IL
  • NPI 1134824410

  Family Medicine

  NPD

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1356790653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N GARY AVE",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601881834",
            "telephone_number": "630-360-2958",
            "fax_number": "630-360-2959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N GARY AVE",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601881834",
            "telephone_number": "630-360-2958",
            "fax_number": "630-360-2959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EETTICKAL",
        "first_name": "SHEENA",
        "middle_name": "ALEENA",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-07",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036147804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sheena.eettickal.2@380.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "135 N Oak St",
            "city": "Hinsdale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605213860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Megan Dzimira, OTR/L
• Alexander E Earl, DC
• Edward Hines Jr. Hospital
• Karen Theresa Edwards
• Susan Steele Edwards, L.I.C.S.W.
• Jennifer Ehrhardt, FNP-C
• Elevate Men'S Health LLC
• Maceo Russell Ellison, M.D.
• Rosemary Fady Elmalh
• Kevin Enberg, D.D.S.

• Family Medicine Physician in Carol Stream, IL
• Providers in Carol Stream, 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 May 9, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.