Individual provider Active NPI

Lyssa N Chacko, MD

  • Gastroenterology Physician
  • Denver, CO
National Provider Identifier
1629115993
Registry record updated Mar 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD431382 Issued in PA
Practice address
1055 Clermont St # Ms 111E
Denver, CO 80220-3808
Phone
(303) 399-8020
NPI assigned
Jan 30, 2007
Last updated
Mar 16, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD431382 PA Primary

Addresses

Primary practice location

1055 Clermont St # Ms 111E
Denver, CO 80220-3808

Mailing address

1055 Clermont St # Ms 111E
Denver, CO 80220-3808
Phone (303) 399-8020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20100518000116 CO Practitioner - GastroenterologyPractitioner - Internal Medicine 4587763289 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of Wisconsin School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physicians IncorporatedGroup PAC ID 3476465667, 3,189 clinicians

Practice addresses (Care Compare)

12605 E 16TH Ave
Uchealth Anschutz Medical Campus
Aurora, CO 80045-2545
Phone (720) 848-0000

13123 E 16TH Ave
Aurora, CO 80045-7106
Phone (720) 777-1234

777 Bannock St
Denver, CO 80204-4507
Phone (303) 436-6000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians, Incorporated CurrentSince Mar 1, 2010 Accepting new patients
Denver Health and Hospital Authority CurrentSince Feb 21, 2010 Accepting new patients
Denver Health and Hospital Authority CurrentSince Feb 21, 2010 Accepting new patients
University Physicians Incorporated CurrentSince Mar 1, 2010 Accepting new patients
Main Line Gastroenterology Associates, PC Gastroenterology Past Accepting new patients

Locations

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

1635 Aurora Ct
Aurora, CO 80045
Phone (720) 848-1060

1055 Clermont St
#111E
Denver, CO 80220
Phone 3033998020 ext. 3018

777 Bannock St
Denver, CO 80204

777 Bannock St
#3240
Denver, CO 80204
Phone (303) 602-2714

Dept 1061
Denver, CO 80256

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268697600000",
    "number": "1629115993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 CLERMONT ST # MS 111E",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802203808",
            "telephone_number": "303-399-8020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 CLERMONT ST # MS 111E",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802203808",
            "telephone_number": "303-399-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "LYSSA",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2010-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "MD431382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.