Individual provider Active NPI

Carol Ann Chincanchan, M.D.

  • Pediatrics Physician
  • San Antonio, TX
National Provider Identifier
1063596716
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
G1350 Issued in TX
Practice address
1102 Barclay St
San Antonio, TX 78207-7161
Phone
(210) 233-7000
Fax
(210) 434-1704
NPI assigned
Oct 25, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X G1350 TX Primary

Addresses

Primary practice location

1102 Barclay St
San Antonio, TX 78207-7161

Mailing address

3066 E Commerce St
San Antonio, TX 78220-1013
Phone (210) 233-7000

Other identifiers 1

IdentifierTypeStateIssuer
126305509MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140821002092 TX Practitioner - Pediatric Medicine 2961620695 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Barrio Comprehensive Family Health Care Center, Inc. CurrentSince Jul 7, 2014 Accepting new patients
Barrio Comprehensive Family Health Care Center, Inc. CurrentSince Jul 7, 2014 Accepting new patients

Locations

1102 Barclay St
San Antonio, TX 78207
Phone (210) 434-0513

14625 Huebner Rd
San Antonio, TX 78230

3066 E Commerce St
San Antonio, TX 78220
Phone (210) 233-7062

Interoperability endpoints

  • Direct secure messaging: carol.chincanchan@commsa.eclinicaldirectplus.com

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, 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": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1063596716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3066 E COMMERCE ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782201013",
            "telephone_number": "210-233-7000",
            "fax_number": "210-277-6387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 BARCLAY ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782077161",
            "telephone_number": "210-233-7000",
            "fax_number": "210-434-1704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHINCANCHAN",
        "first_name": "CAROL",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "G1350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126305509",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.