Keshawn Chancellor, QMHS HS

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

2712 Tangy CT
Dayton, OH 45414-3043

Phone

(937) 988-3196

NPI assigned

Mar 25, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

High School Graduate

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Places, Inc

  • Behavior Technician
  • Dayton, OH
  • NPI 1073132734
  NPD
• Places Incorporated

  • Adult Mental Health Clinic/Center
  • Dayton, OH
  • NPI 1326012360
  NPD (past)

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

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648166400000",
    "number": "1215687900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 W MONUMENT AVE FL 7",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454021274",
            "telephone_number": "937-461-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2712 TANGY CT",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454143043",
            "telephone_number": "937-988-3196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANCELLOR",
        "first_name": "KESHAWN",
        "credential": "QMHS HS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-25",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326012360",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0301947",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Casey Chanatry, DMD
• Ryan M Chanatry, CT
• Edward E. Chance, P.A.
• Kalon Chance
• Cody Chancellor
• Alexia Chandler
• Brianna Chandel Chandler, MD
• Carol Chandler
• Cassandra Chandler, MASTERS DEGREE
• Jessica Deloris Chandler, PA PROGRAM MANGER

• Behavior Technician in Dayton, OH
• Providers in Dayton, OH by specialty
• Behavior Technician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.