Active NPI
Chelimo Chamberlain
- Dentist
- Hickory, NC
National Provider Identifier
1063643484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9903
- Practice address
- 3070 11TH Avenue Dr SE
Hickory, NC 28602-8336 - Phone
- (828) 695-5778
- NPI assigned
- Aug 3, 2009
- Last updated
- Sep 7, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 9903 | NC | Primary |
Addresses
Primary practice location
3070 11TH Avenue Dr SE
Hickory, NC 28602-8336
Mailing address
200 E 2ND Ave
Gastonia, NC 28052-4358
Phone (704) 874-1904
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160401000357 | NC | Order and Referring Only - Oral Surgery | 2860799079 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1249257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473206400000",
"number": "1063643484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E 2ND AVE",
"city": "GASTONIA",
"state": "NC",
"postal_code": "280524358",
"telephone_number": "704-874-1904",
"fax_number": "704-874-0707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3070 11TH AVENUE DR SE",
"city": "HICKORY",
"state": "NC",
"postal_code": "286028336",
"telephone_number": "828-695-5778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAMBERLAIN",
"first_name": "CHELIMO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-03",
"last_updated": "2016-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "9903",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hickory, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.