NPIMap

Individual provider Active NPI

Kamal K Chopra, MD

  • Family Medicine Physician
  • Carlinville, IL
National Provider Identifier
1598762262
Registry record updated Aug 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-057724 Issued in IL
Practice address
604 N Broad St
Carlinville, IL 62626-1021
Phone
(217) 854-9411
Fax
(217) 854-2858
NPI assigned
Jul 7, 2005
Last updated
Aug 4, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-057724 IL Primary
Internal Medicine Physician 207R00000X 036057724 IL

Addresses

Primary practice location

604 N Broad St
Carlinville, IL 62626-1021

Mailing address

604 N Broad St
Carlinville, IL 62626-1021
Phone (217) 854-9411

Other identifiers 2

IdentifierTypeStateIssuer
036057724MedicaidIL
371406119001MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051212000217 IL Practitioner - Internal Medicine 9133105554 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carlinville Medical Clinic IncGroup PAC ID 7719933928, 3 clinicians

Practice addresses (Care Compare)

604 N Broad St
Carlinville, IL 62626-1021
Phone (217) 854-9411

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-057724ILMDFamily Medicine Physician
036057724ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carlinville Medical Clinic, Inc. Internal Medicine CurrentSince Mar 1, 2001 Accepting new patients
Carlinville Medical Clinic, Inc. Family Medicine CurrentSince Mar 1, 2001 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

604 N Broad St
Carlinville, IL 62626
Phone (217) 854-9411

125 S 2nd St
Girard, IL 62640
Phone (217) 627-3350

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Carlinville Medical Clinic IncCarlinville, IL, CCN 143937 Rural health clinic 5% Or Greater Direct Ownership Interest
Corporate Officer
Corporate Director
W-2 Managing Employee		 Jan 26, 2001
Jan 26, 2001
Jan 26, 2001
Jun 1, 2009

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596499200000",
    "number": "1598762262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 N BROAD ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261021",
            "telephone_number": "217-854-9411",
            "fax_number": "217-854-2858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 N BROAD ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261021",
            "telephone_number": "217-854-9411",
            "fax_number": "217-854-2858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOPRA",
        "first_name": "KAMAL",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-057724",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036057724",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036057724",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371406119001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carlinville, IL

Sources for this page

Verify at the official NPI Registry.