NPIMap

Individual provider Active NPI

Juanchichos T Ventura, MD

  • Family Medicine Physician
  • Hawthorne, NV
National Provider Identifier
1205998366
Registry record updated Mar 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12049 Issued in NV
Practice address
1St and a St
Hawthorne, NV 89415-1510
Phone
(775) 945-2461
Fax
(775) 945-2359
NPI assigned
Dec 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 12049 NV Primary

Addresses

Primary practice location

1St and a St
Hawthorne, NV 89415-1510

Mailing address

PO Box 1510
Hawthorne, NV 89415-1510
Phone (775) 945-2461

Other identifiers 1

IdentifierTypeStateIssuer
12049OtherNVNEVADA LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210603001237 TN Practitioner - Family Practice 7416969506 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ipc Pac Healthcare Services of Tennessee PCGroup PAC ID 0840587572, 74 clinicians
NV Pacs 2 LLCGroup PAC ID 0941550578, 119 clinicians

Practice addresses (Care Compare)

100 Netherland LN
Kingsport, TN 37660-7245
Phone (423) 245-0360

3530 Keith St NW
Cleveland, TN 37312-4309
Phone (423) 476-3254

505 N Roan St
Johnson City, TN 37601-4740
Phone (423) 975-2000

Hospital & facility affiliations

  • Ballad Health Hospice Hospice, Bristol, TN, CCN 441558
  • Wellmont Holston Valley Medical Center Hospital, Kingsport, TN, CCN 440017
  • Indian Path Community Hospital Hospital, Kingsport, TN, CCN 440176
  • Orchardview Post-Acute and Rehabilitation Center Nursing home, Kingsport, TN, CCN 445174
  • Church Hill Post-Acute and Rehabilitation Center Nursing home, Church Hill, TN, CCN 445237
  • Wexford House Nursing home, Kingsport, TN, CCN 445207
  • Asbury Place Kingsport Nursing home, Kingsport, TN, CCN 445481

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
12049NVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ipc Pac Healthcare Services of Tennessee PC CurrentSince Jun 1, 2021 Accepting new patients
NV Pacs 2 LLC CurrentSince Jan 1, 2022 Accepting new patients
CS Pacs 3 Southeast, LLC CurrentSince Nov 18, 2024 Accepting new patients
Mt. Grant General Hospital Past Accepting new patients
Brookhaven TN Opco LLC Past Accepting new patients
Wallace Thomson Hospital Past Accepting new patients
Church Hill TN Opco LLC Past Accepting new patients
LP Rogersville LLC Past Accepting new patients
Mt. Grant General Hospital Past Accepting new patients
Elizabethton Medical Investors LP Past Accepting new patients
Wexford Operating Group LLC Past Accepting new patients
Wellmont Wexford House Past Accepting new patients

Locations

3530 Keith St NW
Cleveland, TN 37312
Phone (423) 309-7567

880 S Mohawk Dr
Erwin, TN 37650
Phone (423) 743-7669

Interoperability endpoints

  • Direct secure messaging: doctor.schumann.1@11938.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/11938/brand/2/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Orchard View Post-Acute and Rehabilitation CenterKingsport, TN, CCN 445174 Skilled nursing facility Adp of the SNF Jun 1, 2021
Church Hill Post-Acute and Rehabilitation CenterChurch Hill, TN, CCN 445237 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2021
Jun 1, 2021

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 12

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205712000000",
    "number": "1205998366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1510",
            "city": "HAWTHORNE",
            "state": "NV",
            "postal_code": "894151510",
            "telephone_number": "775-945-2461",
            "fax_number": "775-945-2359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1ST AND A ST",
            "city": "HAWTHORNE",
            "state": "NV",
            "postal_code": "894151510",
            "telephone_number": "775-945-2461",
            "fax_number": "775-945-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENTURA",
        "first_name": "JUANCHICHOS",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-15",
        "last_updated": "2008-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "12049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA LICENSE",
            "identifier": "12049",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hawthorne, NV

Sources for this page

Verify at the official NPI Registry.