SHOBHA NOOKALA (MD) – Child & Adolescent Psychiatry Physician, NPI 1154336691
Child & Adolescent Psychiatry Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,367 PSYCHIATRY in IL
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Provider Addresses for SHOBHA NOOKALA (MD)
Subway, 900, Main Street, Peoria, Peoria County, Illinois, 61602, United States
SUITE 400
PEORIA, IL 616021005
Phone: (309) 672-3100
Type: Location
A-Reliable Glass & Door Corp., 4128, West Belmont Avenue, Hermosa, Chicago, Jefferson Township, Cook County, Illinois, 60641, United States
CHICAGO, IL 606860001
Phone: (309) 672-4809
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $13.
Total Amount is formed as General ($13) + Research ($0) + Ownership ($0) = $13.
Last reported payment date: 2023-12-11 • Largest payer in this snapshot: Supernus Pharmaceuticals, Inc. ($13).
Total Amount
$13
General + Research + Ownership
Payments
1
Total payment records
General Amount
$13
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-12-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Supernus Pharmaceuticals, Inc. | $13 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-04-27
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040427000105 | I | Psychiatry | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 61602)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| P S Y C H I A T R Y | IL | |
| G A S T R O E N T E R O L O G Y | IL | |
| Family Practice, Psychiatry, Family Practice | NY | |
| Nurse Practitioner | IL | |
| Clinical Psychologist | IL | |
| - | FL | |
| Nurse Practitioner | IL | |
| Gastroenterology, Internal Medicine | WI | |
| P O D I A T R Y | IL | |
| Hospitalist, Family Practice | TX |
Reviews
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