John Kabzeel Yesudas Chacko, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

0101037065 Issued in VA

Practice address

3212 Churchland Boulevard
Suite 8
Chesapeake, VA 23321-5206

Phone

(757) 399-0886

Fax

(757) 399-1191

NPI assigned

Sep 28, 2006

Last updated

Sep 26, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

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

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.

• Eastern Virginia Surgical Associates, Inc.

  • Colon & Rectal Surgery Physician
  • Chesapeake, VA
  • NPI 1376635276
  NPD (past) Authorized official

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190764800000",
    "number": "1972695872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3212 CHURCHLAND BOULEVARD",
            "address_2": "SUITE 8",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "23321",
            "telephone_number": "757-399-0886",
            "fax_number": "757-399-1191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3212 CHURCHLAND BOULEVARD",
            "address_2": "SUITE 8",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233215206",
            "telephone_number": "757-399-0886",
            "fax_number": "757-399-1191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "JOHN",
        "middle_name": "KABZEEL YESUDAS",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101037065",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "VA",
            "license": "0101037065",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "VA",
            "license": "0101037065",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA",
            "identifier": "15421",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC BS",
            "identifier": "174596",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Centerwell Senior Primary Care VA PLLC (CenterWell Senior Primary Care-Chesapeake)
• Krista E. Centric, PPCNP-BC
• Leon Arthur Cerniway, D.M.D.
• Jai C Cha, M.D.
• Alissa Chabi
• Anjan Chakrabarti
• Surya Challa, MD
• Ryan Chamberlain, DPT
• Doris Marie Chance, PA
• Gregory Ming Chandler, M.D.

• Surgery Physician in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Surgery Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2007; 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.