Camille C Chan, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

E-11422 Issued in AR

Practice address

1150 E Matthews Ave Ste 101
Jonesboro, AR 72401-4356

Phone

(870) 936-8000

Fax

(870) 934-3663

NPI assigned

Nov 1, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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 Osteopathy

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.

• St Bernards Hospital Inc.

  • General Acute Care Hospital
  • Jonesboro, AR
  • NPI 1396053096
  Medicare reassignment NPD
• Washington Regional Medical System

  • Hospitalist Physician
  • Fayetteville, AR
  • NPI 1306801485
  Medicare reassignment NPD
• Washington Regional Medical System

  • Family Medicine Physician
  • Farmington, AR
  • NPI 1275839011
  NPD
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  • Clinical Medical Laboratory
  • Jonesboro, AR
  • NPI 1801127030
  NPD (past)

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

{
    "created_epoch": "1477958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539129600000",
    "number": "1154873545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1960",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031960",
            "telephone_number": "870-936-8000",
            "fax_number": "870-934-3663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 E MATTHEWS AVE STE 101",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014356",
            "telephone_number": "870-936-8000",
            "fax_number": "870-934-3663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "CAMILLE",
        "middle_name": "C",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-01",
        "last_updated": "2018-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E-11422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catelyn Chadwick
• Cally Chalker
• Cory Dale Chamberlain
• Cara Chamberlin, MSOT
• Cheryl Chambers
• Kenneth Chan, D.O.
• Traci Marie Chance
• Nickolas Aaron Chancery
• Madison Chandler
• Bailey Chapman

• Pediatrics Physician in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Pediatrics Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; 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.