Chinh Vien Van, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME112971 Issued in FL

Practice address

1005 Mar Walt Drive
Immediate Care Department
Fort Walton Beach, FL 32547-6796

Phone

(850) 863-8219

Fax

(850) 863-8249

NPI assigned

Sep 15, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

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

White-Wilson Medical Center PAGroup PAC ID 4082510607, 48 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Fort Walton-Destin Hospital Hospital, Fort Walton Beach, FL, CCN 100223

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: chinh.van.1@21123.direct.athenahealth.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.

• White-Wilson Medical Center PA

  • Clinic/Center
  • Fort Walton Beach, FL
  • NPI 1467437277
  Medicare reassignment Care Compare group NPD
• WW Medical Center, PA

  • Clinic/Center
  • Fort Walton Beach, FL
  • NPI 1225981707
  Medicare reassignment

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

• Fort Walton Beach Medical Center, Inc.

  • General Acute Care Hospital
  • Ft Walton Beach, FL
  • NPI 1639128820
  Care Compare affiliation

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

{
    "created_epoch": "1284508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403827200000",
    "number": "1124336839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DRIVE",
            "address_2": "IMMEDIATE CARE DEPARTMENT",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476796",
            "telephone_number": "850-863-8219",
            "fax_number": "850-863-8249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 MAR WALT DRIVE",
            "address_2": "IMMEDIATE CARE DEPARTMENT",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476796",
            "telephone_number": "850-863-8219",
            "fax_number": "850-863-8249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN",
        "first_name": "CHINH",
        "middle_name": "VIEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-15",
        "last_updated": "2014-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME112971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL",
            "identifier": "14L8L",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005580200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Devang Yogeshbhai Undaviya
• Suzy Urenda
• Aimee Pooneh Vafaie, MD
• Alexandra Jean Valencik, CRNA
• Eugene Raphael Valentine, M.D.
• Mary Forsyth Vasiloff, AU.D.
• Angela Patricia Vaughn, RBT
• Lauren Z Veal, M.S.- CCC/SLP
• Andres Tomas Vega, DO
• Holly Vehawn, PTA

• Family Medicine Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 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.