Individual provider Active NPI

Jeff D. Chancellor, M.D.

  • Obstetrics & Gynecology Physician
  • Waco, TX
National Provider Identifier
1104886126
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
L3606 Issued in TX
Practice address
7700 Fish Pond Rd
Waco, TX 76710-1031
Phone
(254) 741-4444
NPI assigned
Mar 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X L3606 TX Primary

Addresses

Primary practice location

7700 Fish Pond Rd
Waco, TX 76710-1031

Mailing address

PO Box 847408
Dallas, TX 75284-7408
Phone (254) 724-2111

Other identifiers 1

IdentifierTypeStateIssuer
8F5578OtherTXBLUE SHIELD

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
I20080114000733 TX Practitioner - Obstetrics/Gynecology 7113008343 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Baylor College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health AllianceGroup PAC ID 6305731068, 119 clinicians

Practice addresses (Care Compare)

601 W State Hwy 6 101
Waco Center for Womens Health
Waco, TX 76710-5592
Phone (254) 772-5454

Hospital & facility affiliations

  • Ascension Providence Hospital, Waco, TX, CCN 450042

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L3606TXMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health Alliance CurrentSince Oct 1, 2010 Accepting new patients
Providence Health Alliance CurrentSince Oct 1, 2010 Accepting new patients
Ascension Providence Past Accepting new patients

Locations

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

405 Londonderry Dr
Ste 205
Waco, TX 76712
Phone (254) 572-8683

301 Richland West Cir
Waco, TX 76712
Phone (254) 537-6200

601 W State Highway 6
Ste 101
Waco, TX 76710
Phone (254) 772-5454

Interoperability endpoints

  • Direct secure messaging: jeff.chancellor.1@9635.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184025600000",
    "number": "1104886126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 847408",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752847408",
            "telephone_number": "254-724-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 FISH POND RD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767101031",
            "telephone_number": "254-741-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANCELLOR",
        "first_name": "JEFF",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2007-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "L3606",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "8F5578",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.