Individual provider Active NPI

Achankunju A Chacko, MD

  • Adult Medicine Physician
  • Takoma Park, MD
National Provider Identifier
1508878414
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
D20129 Issued in MD
Practice address
7610 Carroll Ave
Suite # 390
Takoma Park, MD 20912-6384
Phone
(301) 270-5522
Fax
(301) 270-4837
NPI assigned
Aug 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X D20129 MD Primary

Addresses

Primary practice location

7610 Carroll Ave
Suite # 390
Takoma Park, MD 20912-6384

Mailing address

7610 Carroll Ave
Suite # 390
Takoma Park, MD 20912-6384
Phone (301) 270-5522

Other identifiers 1

IdentifierTypeStateIssuer
7959214000MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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
I20110615000481 DC Practitioner - Family Practice 0244417475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Howard University College of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sun Rise Rehab LLCGroup PAC ID 4880783810, 22 clinicians

Practice addresses (Care Compare)

7249 Hanover Pkwy
Suite a
Greenbelt, MD 20770-3608
Phone (301) 613-8923

7610 Carroll Ave
Suite 390
Takoma Park, MD 20912-6323
Phone (301) 270-5522

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D20129MDMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick Health Hospital Inc Past Accepting new patients

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508878414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7610 CARROLL AVE",
            "address_2": "SUITE # 390",
            "city": "TAKOMA PARK",
            "state": "MD",
            "postal_code": "209126384",
            "telephone_number": "301-270-5522",
            "fax_number": "301-270-4837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7610 CARROLL AVE",
            "address_2": "SUITE # 390",
            "city": "TAKOMA PARK",
            "state": "MD",
            "postal_code": "209126384",
            "telephone_number": "301-270-5522",
            "fax_number": "301-270-4837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "ACHANKUNJU",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MD",
            "license": "D20129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7959214000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Takoma Park, MD

Sources for this page

Verify at the official NPI Registry.