Active NPI
Ronald G Chambers I, M.D.
- Family Medicine Physician
- Shasta Lake, CA
National Provider Identifier
1215920319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- G27170
- Practice address
- 4174 Ashby CT
Shasta Lake, CA 96019-9215 - Phone
- (530) 275-3094
- Fax
- (530) 275-0803
- NPI assigned
- Aug 24, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G27170 | CA | Primary |
Addresses
Primary practice location
4174 Ashby CT
Shasta Lake, CA 96019-9215
Mailing address
4174 Ashby CT
Shasta Lake, CA 96019-9215
Phone (530) 275-3094
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05D0714372 | Other | CA | CLIA NUMBER |
| 21565 | Other | CA | WEB MD ACCT NUMBER |
| BLUE CROSS | Other | CA | 00G271700 |
| 4490118 | Other | CA | MEDI-CAL PIN NUMBER |
| 1243370356 | Other | CA | VITERA ACCOUNT |
| 1861616567 | Medicaid | CA | |
| ZZZ01370Z | Other | CA | MEDICARE PTAN |
| BLUE SHIELD | Other | CA | 00G271700 |
| ZZZ01370Z | Other | MEDICARE ID | |
| 00G271700 | Other | CA | BLUE SHIELD ID NUMBER |
| 00G271700 | Medicaid | CA | |
| 013204 | Other | CA | AMER BD OF FAMILY PRACTIC |
| G27170 | Other | CA | CALIF STATE LICENSE NUMBE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151014000756 | CA | Order and Referring Only - Family Practice | 4981650223 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27170 | CA | MD | Clinical Psychologist |
| G27170 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1215920319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4174 ASHBY CT",
"city": "SHASTA LAKE",
"state": "CA",
"postal_code": "960199215",
"telephone_number": "530-275-3094",
"fax_number": "530-275-0803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4174 ASHBY CT",
"city": "SHASTA LAKE",
"state": "CA",
"postal_code": "960199215",
"telephone_number": "530-275-3094",
"fax_number": "530-275-0803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAMBERS",
"first_name": "RONALD",
"middle_name": "G",
"name_prefix": "Dr.",
"name_suffix": "I",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-24",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "G27170",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA NUMBER",
"identifier": "05D0714372",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WEB MD ACCT NUMBER",
"identifier": "21565",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "00G271700",
"identifier": "BLUE CROSS",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL PIN NUMBER",
"identifier": "4490118",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VITERA ACCOUNT",
"identifier": "1243370356",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1861616567",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "ZZZ01370Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "00G271700",
"identifier": "BLUE SHIELD",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ID",
"identifier": "ZZZ01370Z",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD ID NUMBER",
"identifier": "00G271700",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G271700",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMER BD OF FAMILY PRACTIC",
"identifier": "013204",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIF STATE LICENSE NUMBE",
"identifier": "G27170",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shasta Lake, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.