NPIMap

Individual provider Active NPI

Jobin Koshy John, M.D.

  • Family Medicine Physician
  • Chicago, IL
National Provider Identifier
1376870311
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036130077 Issued in IL
Practice address
1801 W Taylor St
Chicago, IL 60612-4795
Phone
(312) 996-3253
NPI assigned
Nov 12, 2009
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036130077 IL Primary

Addresses

Primary practice location

1801 W Taylor St
Chicago, IL 60612-4795

Mailing address

1209 N Oak Park Ave
Oak Park, IL 60302-1254
Phone (312) 953-1086

Other practice location 1

3800 W Madison St
Chicago, IL 60624
Phone (773) 826-6600

Other practice location 2

3800 W Madison St
Chicago, IL 60624
Phone (773) 826-6600

Other identifiers 1

IdentifierTypeStateIssuer
036130077MedicaidIL

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
I20170104001369 IL Practitioner - Family Practice 5799066817 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

840 S Wood St MC
958 Uic Surgery
Chicago, IL 60612-4325
Phone (312) 355-0104

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue45
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Jul 1, 2018 Accepting new patients
Access Community Health Network CurrentSince Dec 12, 2016 Accepting new patients
The Board of Trustees of the University of Illinois Current Accepting new patients
Access Community Health Network CurrentSince Dec 12, 2016 Accepting new patients
Access Community Health Network Current Accepting new patients
The Board of Trustees of the University of Illinois CurrentSince Jul 1, 2018 Accepting new patients
The Board of Trustees of the University of Illinois Family Medicine Past Accepting new patients
Board of Trustees of the University of Illinois Past Accepting new patients

Locations

1801 W Taylor St
Chicago, IL 60612
Phone (312) 355-1700

1801 W Taylor St
#3F
Chicago, IL 60612
Phone (312) 355-4300

3800 W Madison St
Chicago, IL 60624
Phone (773) 826-6600

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-4210

840 S Wood St
#958
Chicago, IL 60612
Phone (312) 355-1493

845 W Wilson Ave
Chicago, IL 60640
Phone (312) 744-1295

Interoperability endpoints

  • Direct secure messaging: jjohn17147@uihealth.direct-ci.com
  • Direct secure messaging: jjohn276102@direct.myadvocateaurora.org

Organizations & group practices 8

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 4

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": "1257984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1376870311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 N OAK PARK AVE",
            "city": "OAK PARK",
            "state": "IL",
            "postal_code": "603021254",
            "telephone_number": "312-953-1086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W TAYLOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124795",
            "telephone_number": "312-996-3253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3800 W Madison St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60624",
            "country_code": "US",
            "telephone_number": "773-826-6600",
            "fax_number": "773-826-1407",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3800 W Madison St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60624",
            "country_code": "US",
            "telephone_number": "773-826-6600",
            "fax_number": "773-826-1407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHN",
        "first_name": "JOBIN",
        "middle_name": "KOSHY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-12",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036130077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036130077",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.