Jordan M Chilla, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG003411 Issued in PA

Practice address

402 Bayard Rd Ste 200
Kennett Square, PA 19348-1862

Phone

(484) 770-8132

NPI assigned

Jul 5, 2018

Last updated

Mar 16, 2020By the provider in NPPES

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

Other names 1

• Jordan M Heidelbaugh Former name

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pennsylvania College of Optometry, 2018

Medicare assignment

May accept Medicare assignment

Group practices

Ganly Vision Care, PCGroup PAC ID 8921153503, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ganly Vision Care, PC

  • Optometrist
  • Kennett Square, PA
  • NPI 1922235456
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1530748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584316800000",
    "number": "1174019962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 BAYARD RD STE 200",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193481862",
            "telephone_number": "484-770-8132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 BAYARD RD STE 200",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193481862",
            "telephone_number": "484-770-8132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILLA",
        "first_name": "JORDAN",
        "middle_name": "M",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-05",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "HEIDELBAUGH",
            "middle_name": "M",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chester County Well-Being, LLC
• Felicia Marie Chew, OTR
• Children and Teen Dental Group of Pennsylvania PC
• Children's Hospital of Philadelphia (Care Network Kennett Square)
• Children's Hospital of Philadelphia (Kennett Square Healthy Weight)
• Christiana Care Health Services Inc (CCHS Behavioral Health PA)
• Christiana Care Health Services Inc (CCHS OB/GYN PA)
• Christiana Care Health Services Inc
• Leslie Church
• Marilyn Nicolette Ciavarra, PT

• Optometrist in Kennett Square, PA
• Providers in Kennett Square, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; 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.