Active NPI
Jomon M Edakara
- Physical Therapist
- Deerfield, IL
National Provider Identifier
1609094630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05008369A
- Practice address
- 1551 Lake Cook Rd
Deerfield, IL 60015-5651 - Phone
- (847) 374-0500
- NPI assigned
- Apr 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05008369A | IN | Primary |
Addresses
Primary practice location
1551 Lake Cook Rd
Deerfield, IL 60015-5651
Mailing address
1313 Hallberg LN
Parkridge, IL 60068
Other names 1
- Jomon Mathew
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05008369A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723507200000",
"number": "1609094630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1313 HALLBERG LN",
"city": "PARKRIDGE",
"state": "IL",
"postal_code": "60068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1551 LAKE COOK RD",
"city": "DEERFIELD",
"state": "IL",
"postal_code": "600155651",
"telephone_number": "847-374-0500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDAKARA",
"first_name": "JOMON",
"middle_name": "M",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-23",
"last_updated": "2024-08-13",
"certification_date": "2024-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05008369A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JOMON",
"last_name": "MATHEW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Deerfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.