Active NPI
Rafael Comacho Chan, M.D.
- Diagnostic Radiology Physician
- Fort Worth, TX
National Provider Identifier
1033151287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- E2169
- Practice address
- 1450 8TH Ave
Fort Worth, TX 76104-4110 - Phone
- (817) 923-4423
- Fax
- (817) 923-3176
- NPI assigned
- Jun 12, 2006
- Last updated
- Apr 25, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | E2169 | TX | |
| Diagnostic Radiology Physician | 2085R0202X | E2169 | TX | Primary |
Addresses
Primary practice location
1450 8TH Ave
Fort Worth, TX 76104-4110
Mailing address
PO Box 911230
Dallas, TX 75391-1230
Phone (972) 997-8000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8S3354 | Other | TX | BLUE CROSS OF TEXAS |
| 132672009 | Medicaid | TX | |
| 132672010 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prostate Seed Institute | Radiation Oncology | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209081600000",
"number": "1033151287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 911230",
"city": "DALLAS",
"state": "TX",
"postal_code": "753911230",
"telephone_number": "972-997-8000",
"fax_number": "972-467-9605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 8TH AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761044110",
"telephone_number": "817-923-4423",
"fax_number": "817-923-3176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "RAFAEL",
"middle_name": "COMACHO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2008-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "TX",
"license": "E2169",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "TX",
"license": "E2169",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF TEXAS",
"identifier": "8S3354",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "132672009",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "132672010",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.