Individual provider Active NPI

Thomas Carberry, M.D.

  • Pediatric Cardiology Physician
  • Chicago, IL
National Provider Identifier
1487043907
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
4301506609 Issued in MI
Practice address
225 E Chicago Ave # 21
Chicago, IL 60611
Phone
(312) 227-5329
NPI assigned
Jan 21, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X 4301506609 MI Primary

Addresses

Primary practice location

225 E Chicago Ave # 21
Chicago, IL 60611

Mailing address

225 E Chicago Ave # 21
Chicago, IL 60611-2991
Phone (312) 227-5329

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20220727000945 MI Practitioner - Pediatric Medicine 6800278664 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spectrum Health Primary Care PartnersGroup PAC ID 4587568647, 2,283 clinicians

Practice addresses (Care Compare)

100 Michigan Ave NE
Grand Rapids, MI 49503-2560

100 Michigan St NE RM
280 Corewell Health Medical Group West
Grand Rapids, MI 49503-2560
Phone (616) 267-0115

4444 Kalamazoo Ave SE
200 Corewell Health Medical Group West
Kentwood, MI 49508-4600
Phone (616) 391-5600

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301506609MIMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince Sep 21, 2022 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Jul 1, 2022 Accepting new patients
Spectrum Health Hospitals CurrentSince Jul 1, 2022 Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince Sep 21, 2022 Accepting new patients
Spectrum Health Primary Care Partners Pediatric Cardiology CurrentSince Jul 1, 2022 Accepting new patients
Spectrum Health Hospitals Pediatric Cardiology CurrentSince Jul 1, 2022 Accepting new patients

Locations

225 E Chicago Ave
#21
Chicago, IL 60611
Phone (312) 227-2200

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

25 Michigan St NE
Ste 4200
Grand Rapids, MI 49503
Phone (616) 267-9150

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

588 E Lakewood Blvd
Fl 1
Holland, MI 49424
Phone (616) 494-5800

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

2009 Holton Rd
North Muskegon, MI 49445
Phone (231) 291-8020

225 N State St
Reed City, MI 49677
Phone (231) 832-7108

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

3950 Hollywood Rd
Ste 240
Saint Joseph, MI 49085
Phone (269) 408-1852

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

Interoperability endpoints

  • Direct secure messaging: tcarberry483058@epic00.corewelldirect.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1421798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656028800000",
    "number": "1487043907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 E CHICAGO AVE # 21",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112991",
            "telephone_number": "312-227-5329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E CHICAGO AVE # 21",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60611",
            "telephone_number": "312-227-5329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARBERRY",
        "first_name": "THOMAS",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-21",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "MI",
            "license": "4301506609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.