DR. BONEY MATTATHETHU NINAN M.D
NPI 1811204019
Internal Medicine in Chicago, IL

Q: What is Boney Ninan's NPI number?

The NPI number for Boney Ninan is 1811204019. It was assigned to this individual provider in the NPPES registry on September 9, 2010.

Q: What is Boney Ninan's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Q: When was this NPI record last updated?

The NPPES record for Boney Ninan was last updated on November 30, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 09, 2010PECOS EnrolledAccepts Medicare Assignment

1900 W POLK ST, MEDICINE, CHICAGO, IL 60612(312) 864-7203 Get Directions Write a Review

NPPES record last updated: November 30, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Dr. Boney Mattathethu Ninan M.d NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. BONEY MATTATHETHU NINAN M.D (NPI 1811204019) is an individual internal medicine provider in Chicago, Illinois, licensed in Illinois (125057406) and active in the NPI registry since September 2010. He is enrolled in Medicare PECOS and is a graduate of Other (2005).

NPPES Registry Identity

NPI1811204019

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameDR. BONEY MATTATHETHU NINANCredential: M.D

Location Address1900 W POLK ST, MEDICINEChicago, IL 60612-3723

Mailing Address1548 W Harrison St, Apt 3 BChicago, IL 60607-3169 · (630) 398-1030

Phone(312) 864-7203

Sole ProprietorNo

Medical School CMSOtherGraduated 2005

Enumeration DateSeptember 9, 2010

Last NPPES UpdateNovember 30, 2021

NPPES CertifiedNovember 30, 2021

✔ NPI 1811204019 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in IL · 125057406

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

1900 W POLK ST, Chicago, IL 60612

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Boney Mattathethu Ninan M.d is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5092001321

PECOS Enrollment IDI20160912002491

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Boney Ninan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group

1,687 mi

Health Maintenance Organization

3527 W FLORIDA AVE
Hemet, CA 92545

Reassigned Medicare billing, California enrollment
5,228 clinicians in this Medicare group

NPI 1013433465 (877) 608-0044

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 60612 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$138.86 typical visit price

range $60.08 – $183.39

Typical copayment $34.71 (range $15.02 – $45.84)

Most-billed visit code 99204

Established Patient

$105.70 typical visit price

range $18.97 – $148.12

Typical copayment $26.42 (range $4.74 – $37.03)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CARMENCITA GARCIA SENSENG MD

Pathology (Anatomic Pathology & Clinical Pathology)

1900 W POLK ST
CHICAGO, IL 60612

Cook County (312) 864-7561

DR. REBECCA BOWER-LEWIS M.D.

Emergency Medicine

1900 W POLK ST, SUITE 1053
CHICAGO, IL 60612

Cook County (312) 864-0060

JOHN STROGER JR. HOSPITAL OF THE COOK COUNTY

General Acute Care Hospital

1900 W POLK ST, DEPT OF EM 10TH FLOOR
CHICAGO, IL 60612

Cook County (312) 864-0060

SARAH AHMED CRNA

Nurse Anesthetist, Certified Registered

1900 W POLK ST
CHICAGO, IL 60612

Cook County (312) 864-0452

MS. JENNIFER MARY DUFF APN

Nurse Practitioner (Pediatrics)

1900 W POLK ST, 1143
CHICAGO, IL 60612

Cook County (312) 864-4150

DR. MATTHEW Y RHEE M.D.

Emergency Medicine

1900 W POLK ST, DEPARTMENT OF EMERGENCY MEDICINE
CHICAGO, IL 60612

Cook County (312) 864-0062

IRENE STEPHANIE ALEXANDRA ALUEN METZNER M.D.

Internal Medicine

1900 W POLK ST
CHICAGO, IL 60612

Cook County (312) 864-4462

DR. NIVA SHAKYA M.D.

Pediatrics

1900 W POLK ST
CHICAGO, IL 60612

Cook County (312) 864-4505

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Boney Ninan's NPI number?

The NPI number for Boney Ninan is 1811204019. It was assigned to this individual provider in the NPPES registry on September 9, 2010.

Where is Boney Ninan located?

Boney Ninan practices at 1900 W Polk St Medicine, Chicago, IL 60612. The listed phone number is (312) 864-7203.

What is Boney Ninan's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Boney Ninan enrolled in Medicare?

Yes. Boney Ninan is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Boney Ninan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Boney Ninan reassigns Medicare benefits to Southern California Permanente Medical Group (Hemet, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Boney Ninan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Boney Ninan was last updated on November 30, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.