NPIMap

Individual provider Active NPI

CHI Dai Chen, MD

  • Surgery Physician
  • Bennettsville, SC
National Provider Identifier
1033294285
Registry record updated Sep 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
22377 Issued in SC
Practice address
1040 Marlboro Way
Suite 7
Bennettsville, SC 29512-2494
Phone
(843) 479-5858
Fax
(843) 454-1092
NPI assigned
Oct 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 22377 SC Primary

Addresses

Primary practice location

1040 Marlboro Way
Suite 7
Bennettsville, SC 29512-2494

Mailing address

1040 Marlboro Way
Suite 7
Bennettsville, SC 29512-2494
Phone (843) 479-5858

Other identifiers 4

IdentifierTypeStateIssuer
223779MedicaidSC
000000196767OtherSCUNISON
7162826OtherSCAETNA
407687OtherSCWELLCARE

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

State licenses

LicenseStateTypeSpecialty
22377SCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Carolina Surgery Specialists, PLLC Surgery PastSince Jul 1, 2001 Accepting new patients
Marlboro Clinic Corp Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: cchen24152@directmcleodehealth.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347840000000",
    "number": "1033294285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 MARLBORO WAY",
            "address_2": "SUITE 7",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "295122494",
            "telephone_number": "843-479-5858",
            "fax_number": "843-454-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 MARLBORO WAY",
            "address_2": "SUITE 7",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "295122494",
            "telephone_number": "843-479-5858",
            "fax_number": "843-454-1092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEN",
        "first_name": "CHI",
        "middle_name": "DAI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2012-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "22377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "223779",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "000000196767",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7162826",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "407687",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bennettsville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.