Simon Muttanil Chacko Jr., ARNP
Individual provider Active NPI Nurse Practitioner · Tampa, FL
NPI 1477782860 · NPPES record last updated Oct 3, 2025
Key facts
- NPI
- 1477782860
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- APRN9406548 (FL)
- Practice address
- 3117 W Gandy Blvd
Tampa, FL 33611-2927 - Phone
- (872) 231-3162
- Fax
- (702) 977-1496
- NPI assigned
- Jul 7, 2009
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Integrated Rehab Consultants Florida PLLC
Practice addresses (Care Compare)
702 S Kings Ave
Central Park Healthcare and Rehabil
Brandon, FL 33511-5925
Phone (813) 651-1818
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.11 of 100
- Quality
- 70.72
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170303000864 | FL | Practitioner - Nurse Practitioner | 8325322753 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN9406548 | FL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Luxehealth Florida LLC | Current |
Accepting new patients | |
| Dedicated Senior Medical Center of Florida, LLC | Current |
Accepting new patients | |
| Brandon-Riverview Medical Associates PA | Current |
Accepting new patients | |
| Dedicated Senior Medical Center of Florida, LLC | Current |
Accepting new patients | |
| Dedicated Senior Medical Center of Florida, LLC | Current | Accepting new patients | |
| Integrated Rehab Consultants Florida, PLLC | Current |
Accepting new patients | |
| Diabetic'S Choice, LLC | Current |
Accepting new patients | |
| Summit Medical Group, PLLC | Past |
Accepting new patients | |
| Visiting Nurse Association of Florida Inc | Past |
Accepting new patients |
Locations
417 Apollo Beach Blvd
Apollo Beach, FL 33572
Phone (813) 733-5883
851 W Lumsden Rd
Brandon, FL 33511
Phone (813) 661-8998
702 S Kings Ave
Brandon, FL 33511
Phone (813) 651-1818
519 E Bloomingdale Ave
Ste A
Brandon, FL 33511
Phone (813) 655-4100
701 Victoria St
Brandon, FL 33510
Phone (813) 681-4220
4715 S Florida Ave
Lakeland, FL 33813
Phone (863) 209-7003
7050 Ulmerton Rd
Largo, FL 33771
Phone (727) 777-4540
7050 Ulmerton Rd
Apt 210
Largo, FL 33771
1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760
13111 US Highway 301 S
Riverview, FL 33578
Phone (813) 671-0064
5600 Bee Ridge Rd
Ste B
Sarasota, FL 34233
Phone (941) 233-8321
725 S Pine St
Sebring, FL 33870
Phone (863) 385-0161
1709 N Taliaferro Ave
Tampa, FL 33602
Phone (813) 223-4623
3117 W Gandy Blvd
Tampa, FL 33611
Phone (813) 261-5500
4610 S Manhattan Ave
Tampa, FL 33611
Phone (813) 752-7000
1026 Albee Farm Rd
Venice, FL 34285
Phone (941) 484-0425
1310 37th St
Vero Beach, FL 32960
Phone (772) 569-5107
300 NW 1st Ave
Williston, FL 32696
Phone (352) 528-3561
Interoperability endpoints
- schacko@landmarkhealth-direct.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APRN9406548 | FL | Yes |
Addresses
Primary practice location
3117 W Gandy Blvd
Tampa, FL 33611-2927
Mailing address
PO Box 7410884
Chicago, IL 60674-0884
Phone (702) 899-0595
Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2025. 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.