Individual provider Active NPI

Praveen Jeyaseelan, MD

  • Neuro-ophthalmology Physician
  • Chicago, IL
National Provider Identifier
1619522067
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuro-ophthalmology PhysicianTaxonomy code 207WX0109X
License
ME148721 Issued in FL
Practice address
333 E Ontario St Apt 3309B
Chicago, IL 60611-8401
Phone
(443) 962-5153
NPI assigned
Aug 2, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neuro-ophthalmology Physician 207WX0109X ME148721 FL Primary

Addresses

Primary practice location

333 E Ontario St Apt 3309B
Chicago, IL 60611-8401

Mailing address

333 E Ontario St Apt 3309B
Chicago, IL 60611-8401
Phone (443) 962-5153

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20210817002445 WV Practitioner - Ophthalmology 2860897675 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Medical Ctr Dr
Morgantown, WV 26506-1200
Phone (304) 598-4865

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.34 of 100Reported as apm
Quality
79.86
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery16

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1018WVMDProfessional Counselor
ME148721FLMDNeuro-ophthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Virginia University Medical Corporation Current Accepting new patients
Health and Education Building CurrentSince Aug 11, 2021 Accepting new patients
West Virginia University Medical Corporation CurrentSince Aug 11, 2021 Accepting new patients

Locations

16 Sterling Dr
Ste 102
Bridgeport, WV 26330
Phone (681) 342-2133

1 Medical Center Dr
Morgantown, WV 26506
Phone (304) 293-4500

Interoperability endpoints

  • Direct secure messaging: pjeyaseelan265761@direct.wvuhsdirect.com

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 2

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": "1564704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1619522067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 E ONTARIO ST APT 3309B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606118401",
            "telephone_number": "443-962-5153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 E ONTARIO ST APT 3309B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606118401",
            "telephone_number": "443-962-5153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEYASEELAN",
        "first_name": "PRAVEEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-02",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0109X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Neuro-ophthalmology",
            "state": "FL",
            "license": "ME148721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.