Shinymol John Chacko, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301075416 Issued in MI

Practice address

7717 N Orange Prairie Rd
Peoria, IL 61615-9323

Phone

(309) 589-6800

NPI assigned

Jul 13, 2007

Last updated

Apr 17, 2013By the provider in NPPES

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Danville Vamc

  • Department of Veterans Affairs (VA) Pharmacy
  • Peoria, IL
  • NPI 1336197284
  NPD (past)

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

{
    "created_epoch": "1184284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366156800000",
    "number": "1487853156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7717 N ORANGE PRAIRIE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616159323",
            "telephone_number": "309-589-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7717 N ORANGE PRAIRIE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616159323",
            "telephone_number": "309-589-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "SHINYMOL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-13",
        "last_updated": "2013-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301075416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Central Illinois Preventive Services LLC
• Central Illinois Radiation Oncology Physicians, LTD
• Central Illinois Radiological Associates, LTD. (Central Illinois Radiological Associates)
• Central Illinois Rehabilitation Associates Inc SC
• Dexter Cervantes, O.T.
• Amitoj Singh Chadha, MBBS
• Deboshruti Chakraborty, M.B.B.S
• Shruti Chakravarthy, MD
• Kristen Ann Chambers-Damm, M.D.
• Bradley A Chambers, D.O

• Internal Medicine Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.