Active NPI
Shara L Kronmal, M.D., PH.D.
- Child & Adolescent Psychiatry Physician
- Chicago, IL
National Provider Identifier
1407898703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 036093149
- Practice address
- 5548 S Kenwood Ave
Rear Coach House
Chicago, IL 60637-1714 - Phone
- (773) 684-8250
- Fax
- (773) 943-6368
- NPI assigned
- Jun 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 036093149 | IL | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | 036093149 | IL | Primary |
Addresses
Primary practice location
5548 S Kenwood Ave
Rear Coach House
Chicago, IL 60637-1714
Mailing address
5548 S Kenwood Ave
Chicago, IL 60637-1714
Phone (773) 684-8250
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001632932 | Other | IL | BLUE CROSS BLUE SHIELD |
| 036093149 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2019 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407888000000",
"number": "1407898703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5548 S KENWOOD AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606371714",
"telephone_number": "773-684-8250",
"fax_number": "773-943-6368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5548 S KENWOOD AVE",
"address_2": "REAR COACH HOUSE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606371714",
"telephone_number": "773-684-8250",
"fax_number": "773-943-6368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRONMAL",
"first_name": "SHARA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "M.D., PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-12",
"last_updated": "2014-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IL",
"license": "036093149",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "IL",
"license": "036093149",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0001632932",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036093149",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.