Active NPI
Jay Michael Channick, M.D.
- Nephrology Physician
- Coronado, CA
National Provider Identifier
1083912869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- G16554
- Practice address
- 821 B Ave
Coronado, CA 92118-2615 - Phone
- (619) 435-4794
- NPI assigned
- Mar 3, 2011
- Last updated
- Mar 3, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | G16554 | CA | Primary |
Addresses
Primary practice location
821 B Ave
Coronado, CA 92118-2615
Mailing address
821 B Ave
Coronado, CA 92118-2615
Phone (619) 435-4794
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G16554 | CA | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299110400000",
"number": "1083912869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "821 B AVE",
"city": "CORONADO",
"state": "CA",
"postal_code": "921182615",
"telephone_number": "619-435-4794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "821 B AVE",
"city": "CORONADO",
"state": "CA",
"postal_code": "921182615",
"telephone_number": "619-435-4794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANNICK",
"first_name": "JAY",
"middle_name": "MICHAEL",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-03",
"last_updated": "2011-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "CA",
"license": "G16554",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coronado, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.