Active NPI
Deena Hassaballa, D.O.
- Physical Medicine & Rehabilitation Physician
- Chicago, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 036.132197
- Practice address
- 355 E Erie St
Chicago, IL 60611 - Phone
- (312) 238-1000
- Fax
- (312) 238-8405
- NPI assigned
- May 3, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 036.132197 | IL | Primary |
Addresses
Primary practice location
355 E Erie St
Chicago, IL 60611
Mailing address
355 E Erie St
Chicago, IL 60611-3167
Phone (312) 238-1000
Other practice location 1
201 S 14th St
Herrin, IL 62948-3631
Phone (618) 942-2171
Other practice location 2
405 W Jackson St
Carbondale, IL 62901-1462
Phone (618) 549-0721
Other practice location 3
2 S Hospital Dr
Murphysboro, IL 62966-3333
Phone (618) 684-3156
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036132197 | Medicaid | IL |
Electronic endpoints 3
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dhassaball77054@sih.direct-ci.com | ||
| Direct Messaging Address | dhassaball77054@sih.direct-ci.com | ||
| Direct Messaging Address | dhassaball77054@sih.direct-ci.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, GA, WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 3
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036.132197 | IL | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoebe Physician Group, Inc | Current | Accepting new patients | |
| Southern Illinois Medical Services, NFP | Current | Accepting new patients | |
| Virginia Urgent Care LLC | Past | Accepting new patients | |
| Fastrac Medical, P.C. | Past | Accepting new patients |
Locations
417 W 3rd Ave
Albany, GA 31701
Phone (229) 317-2207
2002 Palmyra Rd
Ste 201
Albany, GA 31701
Phone (229) 312-5802
151 Mayo St
Ste B
Americus, GA 31709
Phone (229) 928-2900
405 W Jackson St
Carbondale, IL 62901
2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300
201 S 14th St
Herrin, IL 62948
Phone (618) 942-2171
2 S Hospital Dr
Murphysboro, IL 62966
Phone (618) 684-3156
Interoperability endpoints
- dhassaball77054@sih.direct-ci.com
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 and National Provider Directory roles.
-
dba SIH Medical Group
- Internal Medicine Physician
- Carbondale, IL
- NPI 1770656837
-
- Clinic/Center
- Albany, GA
- NPI 1487899464
-
dba Shirley Ryan AbilityLab
- Rehabilitation Hospital
- Chicago, IL
- NPI 1205879095
-
- Emergency Medicine Physician
- Joliet, IL
- NPI 1659517597
-
dba NextCare Urgent Care
- Urgent Care Clinic/Center
- Fredericksburg, VA
- NPI 1487838652
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719273600000",
"number": "1679890446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "355 E ERIE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606113167",
"telephone_number": "312-238-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "355 E ERIE ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60611",
"telephone_number": "312-238-1000",
"fax_number": "312-238-8405"
}
],
"practiceLocations": [
{
"address_1": "201 S 14th St",
"address_purpose": "LOCATION",
"city": "Herrin",
"state": "IL",
"postal_code": "629483631",
"country_code": "US",
"telephone_number": "618-942-2171",
"fax_number": "618-351-4846",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "405 W Jackson St",
"address_purpose": "LOCATION",
"city": "Carbondale",
"state": "IL",
"postal_code": "629011462",
"country_code": "US",
"telephone_number": "618-549-0721",
"fax_number": "618-351-4846",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2 S Hospital Dr",
"address_purpose": "LOCATION",
"city": "Murphysboro",
"state": "IL",
"postal_code": "629663333",
"country_code": "US",
"telephone_number": "618-684-3156",
"fax_number": "618-351-4846",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HASSABALLA",
"first_name": "DEENA",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-03",
"last_updated": "2024-06-25",
"certification_date": "2024-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "IL",
"license": "036.132197",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036132197",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dhassaball77054@sih.direct-ci.com",
"affiliation": "N",
"address_1": "405 W Jackson St",
"city": "Carbondale",
"state": "IL",
"country_code": "US",
"postal_code": "629011462",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dhassaball77054@sih.direct-ci.com",
"affiliation": "N",
"address_1": "201 S 14th St",
"city": "Herrin",
"state": "IL",
"country_code": "US",
"postal_code": "629483631",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dhassaball77054@sih.direct-ci.com",
"affiliation": "N",
"address_1": "2 S Hospital Dr",
"city": "Murphysboro",
"state": "IL",
"country_code": "US",
"postal_code": "629663333",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; 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.