NPIMap

Individual provider Active NPI

Soberekon Melvin Koko, M.D.

  • Neurology Physician
  • Chicago, IL
National Provider Identifier
1992918866
Registry record updated Jul 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
036.117531 Issued in IL
Practice address
326 W 64TH St
Chicago, IL 60621-3114
Phone
(773) 962-3900
Fax
(773) 896-2591
NPI assigned
May 8, 2007
Last updated
Jul 16, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 036.117531 IL Primary

Addresses

Primary practice location

326 W 64TH St
Chicago, IL 60621-3114

Mailing address

326 W 64TH St
Chicago, IL 60621-3114
Phone (773) 962-3900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20070605000202 IL Practitioner - PsychiatryPractitioner - Neurology 2860590528 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
PsychiatryAlso: Neurology
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Sinai Community FoundationGroup PAC ID 5991600405, 247 clinicians

Practice addresses (Care Compare)

20180 S Lagrange Rd
Frankfort, IL 60423-3153
Phone (630) 362-1035

California Ave at 15TH St
Chicago, IL 60608-1858
Phone (773) 542-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.117531ILMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Foundation for Outreach Services CurrentSince Jun 1, 2014 Accepting new patients
Silver Oaks Behavioral, LLC CurrentSince Apr 6, 2020 Accepting new patients
Mount Sinai Community Foundation Current Accepting new patients
Foundation for Emergency Services Current Accepting new patients
Iconpsychologies Current Accepting new patients
Mount Sinai Community Foundation CurrentSince Jul 21, 2025 Accepting new patients
Sinai Community Foundation CurrentSince Jul 21, 2025 Accepting new patients
Foundation for Emergency Services CurrentSince Feb 1, 2014 Accepting new patients
Preventative Mental Healthcare Services Past Accepting new patients
Synergos P.C. Past Accepting new patients

Locations

1501 S California Ave
#7140
Chicago, IL 60608
Phone (773) 257-4758

26460 Network Pl
Chicago, IL 60673
Phone (708) 786-2900

326 W 64th St
Chicago, IL 60621
Phone (773) 962-3900

1004 Pawlak Pkwy
New Lenox, IL 60451
Phone (815) 215-3300

Organizations & group practices 11

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 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": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405468800000",
    "number": "1992918866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 W 64TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606213114",
            "telephone_number": "773-962-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "326 W 64TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606213114",
            "telephone_number": "773-962-3900",
            "fax_number": "773-896-2591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOKO",
        "first_name": "SOBEREKON",
        "middle_name": "MELVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-08",
        "last_updated": "2014-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036.117531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.