NPIMap

Individual provider Active NPI

Chris E Chacko, MD

  • Otolaryngology Physician
  • Evansville, IN
National Provider Identifier
1679731665
Registry record updated Jan 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
01064628-A Issued in IN
Practice address
350 W. Columbia, Suite 310
Evansville, IN 47710-1782
Phone
(812) 425-2646
Fax
(812) 467-7209
NPI assigned
May 28, 2008
Last updated
Jan 6, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 11012804A IN
Otolaryngology Physician 207Y00000X 01064628-A IN Primary

Addresses

Primary practice location

350 W. Columbia, Suite 310
Evansville, IN 47710-1782

Mailing address

PO Box 1510
Evansville, IN 47706-1510
Phone (812) 425-2646

Other identifiers 1

IdentifierTypeStateIssuer
200992660MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101006000863 IN Practitioner - Otolaryngology 8426240631 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Indiana University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Clinic IncGroup PAC ID 3375610116, 411 clinicians

Practice addresses (Care Compare)

350 W Columbia St
Suite 310
Evansville, IN 47710-1782
Phone (812) 425-2646

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01064628-AINMDOtolaryngology Physician
11012804AINMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Clinic, Inc Otolaryngology CurrentSince Jan 1, 2015 Accepting new patients
Deaconess Clinic Inc CurrentSince Jan 1, 2015 Accepting new patients
Deaconess Clinic Inc. Current Accepting new patients

Locations

350 W Columbia St
Ste 310
Evansville, IN 47710
Phone (812) 425-2646

421 Chestnut St
Evansville, IN 47713
Phone (812) 426-6645

1204 Williams St
Oakland City, IN 47660
Phone (812) 749-6187

Interoperability endpoints

  • Direct secure messaging: cchacko46483@direct.deaconess.com

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Deaconess Clinic Oakland CityOakland City, IN, CCN 153936 Rural health clinic Corporate Director Oct 1, 2019
Deaconess Clinic Sherman DrivePrinceton, IN, CCN 153934 Rural health clinic Corporate Director Oct 1, 2019
Deaconess Clinic Ft. BranchFort Branch, IN, CCN 153933 Rural health clinic Corporate Director Oct 1, 2019
Deaconess Clinic Vail StreetPrinceton, IN, CCN 153935 Rural health clinic Corporate Director Oct 1, 2019
Deaconess Clinic SebreeSebree, KY, CCN B03929 Rural health clinic Corporate Director Oct 1, 2019
Deaconess Clinic Dixon RHCDixon, KY, CCN B03930 Rural health clinic Corporate Director Oct 1, 2019
Deaconess Clinic MorganfieldMorganfield, KY, CCN 183968 Rural health clinic Corporate Director Oct 1, 2019

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1211932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420502400000",
    "number": "1679731665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477061510",
            "telephone_number": "812-425-2646",
            "fax_number": "812-467-7209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W. COLUMBIA, SUITE 310",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101782",
            "telephone_number": "812-425-2646",
            "fax_number": "812-467-7209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "CHRIS",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-28",
        "last_updated": "2015-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "11012804A",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IN",
            "license": "01064628-A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200992660",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.