DR. JITHINRAJ EDAKKANAMBETH VARAYIL


Address: 1200 W State St, Rockford, IL 61102
Phone: 8154901600

DR. JITHINRAJ EDAKKANAMBETH VARAYIL (NPI# 1033591847) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1033591847
Entity Type Individual
Full Name DR. JITHINRAJ EDAKKANAMBETH VARAYIL
Credential MD
Practice Address 1200 W State St
Rockford
IL 61102
Mailing Address 1200 W State St
Rockford
IL 61102-2112
Practice Telephone 8154901600
Practice Fax Number 8154901881
Mailing Telephone 8154901600
Mailing Fax Number 8154901881
Enumeration Date 2015-06-29
Last Update Date 2018-08-15
NPI Deactivation Date 07/27/2018
NPI Reactivation Date 2018-08-08
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207Q00000X Family Medicine 125-067838 IL Allopathic & Osteopathic Physicians
N 390200000X Student in an Organized Health Care Education/Training Program 125-067838 IL Student, Health Care

Provider Secondary Practice Location

Address Telephone Number Fax Number
1221 E State St, Rockford, IL 611042231 8159721000 8159721093

Office Location

Street Address 1200 W STATE ST
City ROCKFORD
State IL
Zip Code 61102

Providers in the same location

NPI Name Taxonomy Address Enumeration
1780680827 Barbara B Morgan Nurse Practitioner 1200 W State St, Rockford, IL 61102-2112 2005-06-23
1588271894 Angela Siebold Nurse Practitioner 1200 W State St, Rockford, IL 61102-2112 2020-09-30
1942814322 Jacqueline Paige Cabrera Nurse Practitioner 1200 W State St, Rockford, IL 61102-2112 2020-09-03
1285250951 Aaleeyah Pringle Alim Dentist 1200 W State St, Rockford, IL 61102-2112 2020-06-18
1639792419 Jessica Lauren Cole Physician Assistant 1200 W State St, Rockford, IL 61102-2112 2020-05-27
1437779071 Christian Murillo Physician Assistant 1200 W State St, Rockford, IL 61102-2112 2020-04-23
1033746573 Erin Ashleigh Donahue Physician Assistant 1200 W State St, Rockford, IL 61102-2112 2020-03-25
1609406008 Marissa Dreger Family Medicine 1200 W State St, Rockford, IL 61102-2112 2020-01-24
1962041657 Sabrina Lee Puvalowski Physician Assistant 1200 W State St, Rockford, IL 61102-2112 2019-12-30
1932741717 Jacob Dalton Boehm Physician Assistant 1200 W State St, Rockford, IL 61102-2112 2019-10-12
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1205115383 Renee Lynn Keeney Advanced Practice Midwife 1200 W. State Street, Crusader Community Health, Rockford, IL 61102 2011-08-08
1689895906 Linda Lou O'reilly Local Education Agency (LEA) 1515 S. Meridian Road, Rockford, IL 61102 2007-05-02
1801012992 Jennifer Anne Boyd Developmental Therapist Nia 1515 S. Meridian Rd., Rockford, IL 61102 2007-04-17
1609173434 Kellie J Gibbons Registered Nurse 650 W State Street, Winnebago County Jail Medical Unit, Rockford, IL 61102-0000 2011-02-14
1275708752 Mercy Ambulance Service LLC Ambulance 1025 Campton Dr, Rockford, IL 61102-1066 2008-04-25
1417448424 Brittany Nicole Lambert Student in an Organized Health Care Education/Training Program 8040 Towermont Dr, Rockford, IL 61102-1080 2018-05-24
1164490132 Harlan Johnson Counselor 852 Lakewood Dr, Rockford, IL 61102-1228 2006-03-08
1184137283 Gail Mary Swenson Speech-Language Pathologist 730 Lincoln Park Blvd, Rockford, IL 61102-1429 2017-11-10
1659316339 Institute of Family Care Home Health 417 S Pierpont Ave, Rockford, IL 61102-1656 2006-06-18
1861851438 Walgreen Co Durable Medical Equipment & Medical Supplies 1200 W State St Ste 102, Rockford, IL 61102-2112 2016-02-11
Find all providers in zip 61102

Taxonomy Information

Taxonomy Code 207Q00000X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine

Taxonomy Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition]
- Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences.
- Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1851910350 Charity L Soles Family Medicine 4134 Ashwinton Way, Rockford, IL 61109-3273 2020-04-14
1306250543 Camille Ryan Family Medicine 6050 Northland Dr Ne Ste 200, Rockford, MI 49341-9257 2014-06-16
1396991485 Novella Ann Schafer Family Medicine 3719 Regal Ridge Circle, Rockford, IL 61114-6037 2008-08-08
1417139130 Derek Lanier Family Medicine 8450 Brower Lake Rd Ne, Apt/suite, Rockford, MI 49341-9346 2007-12-04
1144414921 Moses Godofredo Tomacruz Family Medicine 1502 Parkview Ave, Rockford, IL 61107-1821 2007-09-05
1508077165 Robert Dejonge Do PC Family Medicine 350 Northland Dr Ne, Rockford, MI 49341-1401 2007-05-25
1902018641 Julie Stark Family Medicine 3475 So Alpine Rd, Physicians Immediate Care, Rockford, IL 61109-2604 2007-05-04
1205976024 Mohammed Khaleeluddin Family Medicine 1729 Oak Park Drive, Rockford, IL 61107-5510 2007-02-08
1134273238 Swedishamerican Hosptial Family Medicine 3906 N Main St, Suite A, Rockford, IL 61103-1679 2007-01-23
1194897223 Niccole Ranz Family Medicine 2222 E State St, Suite 209, Rockford, IL 61104-1573 2006-11-14
Find all providers in ROCKFORD

Competitor

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City ROCKFORD
Zip Code 61102

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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