Rebecca G Chackalackal, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

33635 Issued in IA

Practice address

University of Iowa Student Health Service
4189 WL
Iowa City, IA 52242-1100

Phone

(319) 335-8370

Fax

(319) 335-7247

NPI assigned

Sep 29, 2005

Last updated

Sep 28, 2007By 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IA

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rchackalackal6636@uihcdirect.org

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.

• State University of Iowa

  dba University of Iowa Health Care

  • Family Medicine Physician
  • Iowa City, IA
  • NPI 1477554814
  Medicare reassignment NPD
• State University of Iowa

  dba Student Health & Wellness

  • Student Health Clinic/Center
  • Iowa City, IA
  • NPI 1285635664
  NPD
• Genesis Medical Education Foundation Inc

  dba Genesis Family Medical Center

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1659322931
  NPD (past)

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190937600000",
    "number": "1609863323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF IOWA STUDENT HEALTH SERVICE",
            "address_2": "4189 WL",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421100",
            "telephone_number": "319-335-8370",
            "fax_number": "319-335-7247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF IOWA STUDENT HEALTH SERVICE",
            "address_2": "4189 WL",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421100",
            "telephone_number": "319-335-8370",
            "fax_number": "319-335-7247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKALACKAL",
        "first_name": "REBECCA",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-29",
        "last_updated": "2007-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "33635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "55711",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1192815",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hakan Cebeci
• Bonnie Marie Cessna, RDH
• Ilay Cetiner, MD
• Gina M Cetta, ARNP
• Ankita Chabra
• Benjamin Stephen Chacko, M.D.
• Michelle Renee Chadbourne, ARNP
• Mayy Chahla, M.D.
• Mohamad Chahrour, MD
• Masoom Chainani

• Family Medicine Physician in Iowa City, IA
• Providers in Iowa City, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; 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.