Theodore Chang, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

E-9787 Issued in AR

Practice address

5328 Northshore CV
North Little Rock, AR 72118-5332

Phone

(501) 225-4001

Fax

(501) 225-1401

NPI assigned

Jun 22, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 15

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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

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.

• Advanced Pathology Solutions, PLLC

  • Clinical Medical Laboratory
  • North Little Rock, AR
  • NPI 1053686964
  Medicare reassignment NPD
• Infinite Genomics

  • Internal Medicine Physician
  • North Little Rock, AR
  • NPI 1740179282
  Medicare reassignment NPD
• Infinite Genomics LLC

  • Anatomic Pathology Physician
  • North Little Rock, AR
  • NPI 1962225896
  NPD
• Blooming Family Dental LLC

  • General Practice Dentistry
  • West Caldwell, NJ
  • NPI 1699261347
  NPD
• Natural State Laboratories, LLC

  • Clinical Medical Laboratory
  • Little Rock, AR
  • NPI 1730658279
  NPD (past)

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1154617843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 NORTHSHORE LN",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "72118",
            "telephone_number": "501-225-1400",
            "fax_number": "501-225-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5328 NORTHSHORE CV",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721185332",
            "telephone_number": "501-225-4001",
            "fax_number": "501-225-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "THEODORE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-22",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OK",
            "license": "28459",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NC",
            "license": "2016-01125",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NJ",
            "license": "25MA10139500",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MO",
            "license": "2016034437",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MS",
            "license": "24453",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MD",
            "license": "D79534",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "LA",
            "license": "304516",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "KS",
            "license": "04-39110",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IN",
            "license": "01077334A",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "ME130294",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "144598",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AZ",
            "license": "52411",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "ID",
            "license": "M-13573",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "76955",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "AR",
            "license": "E-9787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Billy Mitchell Chandler Sr., MD
• Blake Michael Chandler
• Bonnie Harland Chandler, PHARMD
• Jimmy C Chang, MD
• Jonathan Nicholas Chang, M.D.
• Charles a Redmond DDS, PA
• Chase C. Diemer DDS PLLC
• Karen M. Chase, M.D.
• Makyra Chatman
• Chayim Kavanah Wellness LLC

• Anatomic Pathology & Clinical Pathology Physician in North Little Rock, AR
• Providers in North Little Rock, AR by specialty
• Anatomic Pathology & Clinical Pathology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.