Active NPI
Aiden Xiaolou Chavez
- Community Health Worker
- Jackson, MI
National Provider Identifier
1205681467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 101260015
- Practice address
- 1200 N West Ave
Jackson, MI 49202-2179 - Phone
- (800) 284-8288
- NPI assigned
- Apr 22, 2024
- Last updated
- Apr 22, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 101260015 | MI | Primary |
Addresses
Primary practice location
1200 N West Ave
Jackson, MI 49202-2179
Mailing address
21203 W M 60
Homer, MI 49245-8604
Phone (503) 509-8628
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101260015 | MI | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713744000000",
"number": "1205681467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21203 W M 60",
"city": "HOMER",
"state": "MI",
"postal_code": "492458604",
"telephone_number": "503-509-8628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 N WEST AVE",
"city": "JACKSON",
"state": "MI",
"postal_code": "492022179",
"telephone_number": "800-284-8288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAVEZ",
"first_name": "AIDEN",
"middle_name": "XIAOLOU",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-22",
"last_updated": "2024-04-22",
"certification_date": "2024-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "MI",
"license": "101260015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.