Jeffrey William Chudoba, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD21637 Issued in OR

Practice address

2900 Daggett Ave
Klamath Falls, OR 97601-7101

Phone

(541) 205-3974

Fax

(541) 205-5652

NPI assigned

Sep 14, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR, FL2 enrollments

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 2

Specialty

Diagnostic Radiology

Education

University of Miami, LM Miller School of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mori Bean and Brooks IncGroup PAC ID 8820077878, 966 clinicians

Sky Lakes Medical Center IncGroup PAC ID 1052204096, 196 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sky Lakes Medical Center Hospital, Klamath Falls, OR, CCN 380050
• HCA Florida Fawcett Hospital Hospital, Port Charlotte, FL, CCN 100236
• HCA Florida Lawnwood Hospital Hospital, Fort Pierce, FL, CCN 100246
• HCA Florida Gulf Coast Hospital Hospital, Panama City, FL, CCN 100242
• HCA Florida JFK Hospital Hospital, Atlantis, FL, CCN 100080

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Sky Lakes Medical Center Inc

  • General Acute Care Hospital
  • Klamath Falls, OR
  • NPI 1659340370
  Medicare reassignment Care Compare group NPD
• Mori Bean and Brooks Inc

  • Diagnostic Radiology Physician
  • Tampa, FL
  • NPI 1093782070

  OR

  Medicare reassignment Care Compare group NPD
• Sky Lakes Medical Center Inc

  • Community/Retail Pharmacy
  • Klamath Falls, OR
  • NPI 1003654625
  NPD
• Last Frontier Healthcare District

  • Critical Access Hospital
  • Alturas, CA
  • NPI 1487669032

  Diagnostic Radiology

  NPD (past)
• Last Frontier Healthcare District

  • Rural Health Clinic/Center
  • Alturas, CA
  • NPI 1487764064
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sky Lakes Medical Center Inc

  • Occupational Therapist
  • Klamath Falls, OR
  • NPI 1134270911

  Hospital

  Care Compare affiliation
• Sky Lakes Medical Center Inc

  • General Acute Care Hospital
  • Klamath Falls, OR
  • NPI 1659340370
  Care Compare affiliation
• Bay Hospital, Inc

  • General Acute Care Hospital
  • Panama City, FL
  • NPI 1699721589
  Care Compare affiliation
• Fawcett Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Port Charlotte, FL
  • NPI 1417901406
  Care Compare affiliation
• JFK Medical Center Limited Partnership

  • General Acute Care Hospital
  • Atlantis, FL
  • NPI 1326085424
  Care Compare affiliation
• Lawnwood Medical Center Inc

  • General Acute Care Hospital
  • Fort Pierce, FL
  • NPI 1568409647
  Care Compare affiliation

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1104811322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7326",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976020326",
            "telephone_number": "541-205-5652",
            "fax_number": "541-205-3974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 DAGGETT AVE",
            "city": "KLAMATH FALLS",
            "state": "OR",
            "postal_code": "976017101",
            "telephone_number": "541-205-3974",
            "fax_number": "541-205-5652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUDOBA",
        "first_name": "JEFFREY",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "MD21637",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "OR",
            "license": "MD21637",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "232545",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XPY192082",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles L Christensen, MD
• Michael Skylar Christensen
• Suzanne Patricia Christenson, MS
• Owen Christiansen
• Suvendrini H. C. Christopher-Schuhmann, LPC
• Stacy Aline Clair-Johnson
• Brittany Clark
• George Wesley Clark, CRM
• Kimberly Sue Clark, QMHP
• Acacia Teresa Clausing, PSS,YSS,CRM

• Diagnostic Radiology Physician in Klamath Falls, OR
• Providers in Klamath Falls, OR by specialty
• Diagnostic Radiology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; 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.