Active NPI
John E Perchalski, MD
- Family Medicine Physician
- Chinle, AZ
National Provider Identifier
1205817236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 42798
- Practice address
- Hwy 191 and Hospital Road
Chinle Comprehensive Health Care Center
Chinle, AZ 86503 - Phone
- (928) 674-7166
- Fax
- (928) 674-7705
- NPI assigned
- Nov 8, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 42798 | AZ | Primary |
| Family Medicine Physician | 207Q00000X | 35068168 | OH |
Addresses
Primary practice location
Hwy 191 and Hospital Road
Chinle Comprehensive Health Care Center
Chinle, AZ 86503
Mailing address
PO Box PH
Chinle, AZ 86503-8000
Phone (928) 674-7166
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080112518 | Other | OH | RR MEDICARE |
| 0138872 | Medicaid | OH |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42798 | AZ | MD | Family Medicine Physician |
| 35068168 | OH | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lima Memorial Joint Operating Company | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Lima Memorial Health System
- General Acute Care Hospital
- Lima, OH
- NPI 1336144732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131408000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299196800000",
"number": "1205817236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX PH",
"city": "CHINLE",
"state": "AZ",
"postal_code": "865038000",
"telephone_number": "928-674-7166",
"fax_number": "928-674-7705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HWY 191 AND HOSPITAL ROAD",
"address_2": "CHINLE COMPREHENSIVE HEALTH CARE CENTER",
"city": "CHINLE",
"state": "AZ",
"postal_code": "86503",
"telephone_number": "928-674-7166",
"fax_number": "928-674-7705"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERCHALSKI",
"first_name": "JOHN",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-08",
"last_updated": "2011-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "42798",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "35068168",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "080112518",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0138872",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chinle, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.