NPIMap

Individual provider Active NPI

Marionette Sujitha Jayaprakash, M. D.

  • Internal Medicine Physician
  • Joliet, IL
National Provider Identifier
1760655187
Registry record updated Aug 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2019-01640 Issued in NC
Practice address
2000 Glenwood Ave
Suite 107
Joliet, IL 60435-5676
Phone
(815) 741-4445
Fax
(815) 741-3047
NPI assigned
Apr 7, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2019

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 2019-01640 NC Primary
Internal Medicine Physician 207R00000X 036.128479 IL

Addresses

Primary practice location

2000 Glenwood Ave
Suite 107
Joliet, IL 60435-5676

Mailing address

Medical Center Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-1332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20190830001110 NC Practitioner - Internal MedicinePractitioner - General Surgery 1658535620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: General Surgery
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Duke University Affiliated Physicians, Inc.Group PAC ID 3779489588, 452 clinicians

Practice addresses (Care Compare)

101 SW Cary Pkwy
Cary, NC 27511-5562
Phone (919) 467-7678

7200 Creedmoor Rd
Suite 208
Raleigh, NC 27613-1711
Phone (919) 327-1650

Hospital & facility affiliations

  • Duke University Hospital Hospital, Durham, NC, CCN 340030

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.128479ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Affiliated Physician, Inc. Internal Medicine CurrentSince Jan 11, 2021 Accepting new patients
Duke University Affiliated Physicians, Inc. Internal Medicine CurrentSince Jan 11, 2021 Accepting new patients
Duke University Affiliated Physicians, Inc. Internal Medicine Current Accepting new patients
Duke University Affiliated Physicians, Inc. Past Accepting new patients
Raj Patel MD SC Internal Medicine Past Accepting new patients

Locations

7021 Harps Mill Rd
Ste 100
Raleigh, NC 27615
Phone (919) 576-8480

3320 Wake Forest Rd
Ste 310
Raleigh, NC 27609
Phone (919) 855-8911

3320 Wake Forest Rd
Raleigh, NC 27609
Phone (919) 790-1717

7200 Creedmoor Rd
Ste 208
Raleigh, NC 27613
Phone (919) 327-1650

Interoperability endpoints

  • Direct secure messaging: mjayaprakash477914@direct.medicine.duke.edu

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.

Hospital & facility affiliations 6

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": "1207526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565222400000",
    "number": "1760655187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 GLENWOOD AVE",
            "address_2": "SUITE 107",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604355676",
            "telephone_number": "815-741-4445",
            "fax_number": "815-741-3047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAYAPRAKASH",
        "first_name": "MARIONETTE",
        "middle_name": "SUJITHA",
        "credential": "M. D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-07",
        "last_updated": "2019-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2019-01640",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.128479",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

Verify at the official NPI Registry.