Individual provider Active NPI

Sean Chappell

  • Speech-Language Pathologist
  • Chandler, AZ
National Provider Identifier
1033303516
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
TSLP5608 Issued in AZ
Practice address
2040 S Alma School Rd
Suite 1 PMB 500
Chandler, AZ 85286-7075
Phone
(602) 323-0894
Fax
(602) 445-9337
NPI assigned
Aug 28, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X TSLP5608 AZ Primary

Addresses

Primary practice location

2040 S Alma School Rd
Suite 1 PMB 500
Chandler, AZ 85286-7075

Mailing address

13385 W McDowell Rd
Goodyear, AZ 85395-2631
Phone (623) 986-5110

Other practice location 1

13385 W McDowell Rd
Goodyear, AZ 85395
Phone (623) 986-5110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150619001975 AZ Practitioner - Qualified Speech Language Pathologist 1153632948

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TSLP5608AZMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Eleutheria, LLC Speech-Language Pathologist CurrentSince Nov 1, 2014 Accepting new patients

Locations

500 N Bullard Ave
Ste C27
Goodyear, AZ 85338
Phone (623) 986-5110

13385 W McDowell Rd
Goodyear, AZ 85395
Phone (623) 986-5110

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DIJFCD

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1188259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1033303516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13385 W MCDOWELL RD",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952631",
            "telephone_number": "623-986-5110",
            "fax_number": "623-207-9683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2040 S ALMA SCHOOL RD",
            "address_2": "SUITE 1 PMB 500",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852867075",
            "telephone_number": "602-323-0894",
            "fax_number": "602-445-9337"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13385 W McDowell Rd",
            "address_purpose": "LOCATION",
            "city": "Goodyear",
            "state": "AZ",
            "postal_code": "85395",
            "country_code": "US",
            "telephone_number": "623-986-5110",
            "fax_number": "623-207-9683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAPPELL",
        "first_name": "SEAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-28",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AZ",
            "license": "TSLP5608",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.