Individual provider Active NPI

Christine Queval-Chung, FNP-BC

  • Family Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1164919064
Registry record updated Jan 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP10920 Issued in AZ
Practice address
3864 N 27TH Ave
Phoenix, AZ 85017-4703
Phone
(602) 685-6000
Fax
(602) 212-6250
NPI assigned
Apr 16, 2018
Last updated
Jan 13, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP10920 AZ Primary

Addresses

Primary practice location

3864 N 27TH Ave
Phoenix, AZ 85017-4703

Mailing address

14175 W Indian School Rd Ste B4
Goodyear, AZ 85395-8494
Phone (623) 498-9988

Other identifiers 1

IdentifierTypeStateIssuer
441853MedicaidAZ

Other names 1

  • Christine Queval Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180830003470 AZ Practitioner - Nurse Practitioner 1254681836 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Terros, Inc.Group PAC ID 8224077045, 26 clinicians

Practice addresses (Care Compare)

3864 N 27TH Ave
Phoenix, AZ 85017-4703
Phone (602) 685-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Terros Inc CurrentSince Apr 15, 2019 Accepting new patients
Terros, Inc. CurrentSince Apr 15, 2019 Accepting new patients
Terros, Inc. Current Accepting new patients
Terros, Inc. Past Accepting new patients

Locations

3864 N 27th Ave
Phoenix, AZ 85017
Phone (602) 358-0078

4909 E McDowell Rd
Phoenix, AZ 85008
Phone (602) 244-9591

Interoperability endpoints

  • Direct secure messaging: christine.quevalchung.p1@direct.terros.nextgenshare.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578873600000",
    "number": "1164919064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14175 W INDIAN SCHOOL RD STE B4",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853958494",
            "telephone_number": "623-498-9988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3864 N 27TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850174703",
            "telephone_number": "602-685-6000",
            "fax_number": "602-212-6250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEVAL-CHUNG",
        "first_name": "CHRISTINE",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-16",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP10920",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "441853",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINE",
            "last_name": "QUEVAL",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.