NPIMap

Individual provider Active NPI

Siju T Chacko, M.D.

  • Infectious Disease Physician
  • Merrillville, IN
National Provider Identifier
1720017262
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
01064885A Issued in IN
Practice address
200 E 86TH PL
Merrillville, IN 46410-6258
Phone
(219) 972-1547
Fax
(219) 972-1641
NPI assigned
Jun 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036101193 IL
Infectious Disease Physician 207RI0200X 01064885A IN Primary

Addresses

Primary practice location

200 E 86TH PL
Merrillville, IN 46410-6258

Mailing address

PO Box 10667
Merrillville, IN 46411-0667
Phone (219) 972-1547

Other identifiers 2

IdentifierTypeStateIssuer
200892400MedicaidIN
036101193MedicaidIL

Other names 1

  • Dr. Siju T Chacko Former name

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
I20080709000094 IN Practitioner - Infectious Disease 0840274718 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious Disease
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infectious Disease Specialists PCGroup PAC ID 4981691862, 12 clinicians

Practice addresses (Care Compare)

2701 Leonard Dr
Suite B
Valparaiso, IN 46383-7121
Phone (219) 972-1547

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.1 of 100Reported as group
Quality
70.56
Improvement activities
40
Cost
72.91

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036101193ILMDInternal Medicine Physician
01064885AINMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Infectious Disease Specialists PC Infectious Disease CurrentSince Jul 1, 2008 Accepting new patients
Lakeshorehealthcare PastSince Jan 1, 2010 Accepting new patients

Locations

9143 Indianapolis Blvd
Highland, IN 46322
Phone (219) 972-1547

200 E 86th Pl
Merrillville, IN 46410
Phone (219) 649-2750

2701 Leonard Dr
#A
Valparaiso, IN 46383
Phone (219) 464-9800

2701 Leonard Dr
#B
Valparaiso, IN 46383
Phone (219) 464-9800

Organizations & group practices 2

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 7

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": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716422400000",
    "number": "1720017262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10667",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464110667",
            "telephone_number": "219-972-1547",
            "fax_number": "219-972-1641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E 86TH PL",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106258",
            "telephone_number": "219-972-1547",
            "fax_number": "219-972-1641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "SIJU",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036101193",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "IN",
            "license": "01064885A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200892400",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036101193",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SIJU",
            "last_name": "CHACKO",
            "middle_name": "T",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Merrillville, IN

Sources for this page

Verify at the official NPI Registry.