Justin Chang, DO, FAAHPM

Primary specialty

Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X

License

20A18091 Issued in CA

Practice address

517 3Rd St Ste 2
Eureka, CA 95501-0460

Phone

(707) 442-5683

NPI assigned

Jul 27, 2012

Last updated

Aug 16, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of North Texas HSC, College of Osteopathic Med, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mendocino Care NetworkGroup PAC ID 3173950987, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: justin.chang.1@20518.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/20518/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mendocino Care Network

  dba Madrone Care Network

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Ukiah, CA
  • NPI 1083255095
  Medicare reassignment Care Compare group NPD
• Vynca Medical Associates PA

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Houston, TX
  • NPI 1861144842
  NPD (past)

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

{
    "created_epoch": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629072000000",
    "number": "1265788228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8690 SIERRA COLLEGE BLVD STE 160-306",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956615961",
            "telephone_number": "822-332-8896",
            "fax_number": "512-777-3130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 3RD ST STE 2",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955010460",
            "telephone_number": "707-442-5683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "JUSTIN",
        "credential": "DO, FAAHPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-27",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "DO1879",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS016066",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NV",
            "license": "DO1879",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "CA",
            "license": "20A18091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "13526128",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265788228",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jace Haylings Chalon, RN, PHN
• Lyndsey Chamberlain, PHARMD
• Ashley Ann Chambers
• Cathy Chandler-Klein, MFT
• Angel Chandra
• Changing Tides Family Services
• Changing Tides Family Services
• Changing Tides Family Services
• Changing Tides Family Services
• Mona Chapa-Perkins

• Hospice and Palliative Medicine (Family Medicine) Physician in Eureka, CA
• Providers in Eureka, CA by specialty
• Hospice and Palliative Medicine (Family Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.