Nisha Chandran, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036114562 Issued in IL

Practice address

621 Roxbury Rd
Rockford, IL 61107-5077

Phone

(815) 397-3350

Fax

(815) 227-2992

NPI assigned

Jul 18, 2006

Last updated

May 2, 2012By 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 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL

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

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.

• Advocate Health and Hospitals Corporation

  dba Advocate Medical Group

  • Multi-Specialty Clinic/Center
  • Oak Brook, IL
  • NPI 1700824455
  Medicare reassignment NPD
• Advocate Health and Hospitals Corporation

  dba Advocate Children's Hospital

  • Children's Hospital
  • Oak Lawn, IL
  • NPI 1508315516
  NPD

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335916800000",
    "number": "1649299967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 ROXBURY RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075077",
            "telephone_number": "815-397-3350",
            "fax_number": "815-227-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 ROXBURY RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075077",
            "telephone_number": "815-397-3350",
            "fax_number": "815-227-2992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDRAN",
        "first_name": "NISHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2012-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "036114562",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036114562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036114562",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL HEALTH CONNECT",
            "identifier": "07100059",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05632081",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michiao E Chai
• Amaan Chalisa
• Danielle Challenger, LPN, CNA
• Daniel F Chamberlain, MD
• Meredith Chance, LCSW
• Changes Place
• Judy Chanthalangsy, O.D.
• Viengkeo Chanthaloth- Phasouk, LCSW
• Logan John Chapman-Neal
• Heather Chapman

• Pediatrics Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; 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.