Khayriyyah E.T. Chandler, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25MB09223100 Issued in NJ

Practice address

25A Tanner St
Haddonfield, NJ 08033-2403

Phone

(856) 874-8194

Fax

(856) 210-7068

NPI assigned

Oct 8, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Dr. Khayriyyah E.T. Mack Former name

Medicare fee-for-service enrollment

Enrolled in NJ

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

Specialty

Family Practice

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Atlanticare Physician Group PA 506 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cwc@direct.meditouchehr.com

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.

• Atlanticare Physician Group PA

  • Clinic/Center
  • Egg Harbor Township, NJ
  • NPI 1093829608

  Family Medicine, NJ

  Medicare reassignment Care Compare group NPD
• Atlanticare Urgent Care Physicians LLC

  • Urgent Care Clinic/Center
  • Sicklerville, NJ
  • NPI 1083991616

  NJ

  Medicare reassignment NPD
• Essential Diagnostics, P.a.

  • Internal Medicine Physician
  • Princeton, NJ
  • NPI 1376245753

  NJ

  Medicare reassignment NPD
• Virtua Medical Group, PA

  • Family Medicine Physician
  • Marlton, NJ
  • NPI 1649226515

  Family Medicine, NJ

  Medicare reassignment NPD
• Atlanticare Physician Group, PA

  • Urgent Care Clinic/Center
  • Galloway, NJ
  • NPI 1003820622
  NPD
• Virtua Medical Group, PA

  • Orthopaedic Surgery Physician
  • Delran, NJ
  • NPI 1841087988
  NPD
• Forkidcare LLC

  • Pediatric Skilled Nursing Facility
  • Voorhees, NJ
  • NPI 1770540171
  NPD (past)
• Inspira Health Network Medical Group, P.C.

  • Multi-Specialty Clinic/Center
  • Glassboro, NJ
  • NPI 1922177856
  NPD (past)

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

{
    "created_epoch": "1223424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446681600000",
    "number": "1104077130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25A TANNER ST",
            "city": "HADDONFIELD",
            "state": "NJ",
            "postal_code": "080332403",
            "telephone_number": "856-874-8194",
            "fax_number": "856-210-7068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25A TANNER ST",
            "city": "HADDONFIELD",
            "state": "NJ",
            "postal_code": "080332403",
            "telephone_number": "856-874-8194",
            "fax_number": "856-210-7068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDLER",
        "first_name": "KHAYRIYYAH",
        "middle_name": "E.T.",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-08",
        "last_updated": "2015-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "OT012192",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS015236",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB09223100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KHAYRIYYAH",
            "last_name": "MACK",
            "middle_name": "E.T.",
            "prefix": "DR.",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Amy Beth Carnall, APN,C, DNP
• Jose A Carreras, M.D.
• Stephen M Carroll, LCSW
• CCS Dental LLC
• Center for Intimate Relationships L.L.C.
• Cathy Ann Chapman, M.S., CCC
• Ha Young Choi
• Christine T. Clancey, O.D.
• Allison Clark, D.D.S.
• Bernice L Clark, C.R.N.P.

• All providers in Haddonfield, NJ
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.