Jimmy Dean Chubbuck, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20387 Issued in WA

Practice address

2120 Ryan Rd
Buckley, WA 98321-9115

Phone

(360) 829-1111

NPI assigned

Apr 10, 2007

Last updated

Nov 27, 2012By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Rainier State School

  • Intellectual Disabilities Intermediate Care Facility
  • Buckley, WA
  • NPI 1164547626
  NPD (past)

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353974400000",
    "number": "1285857136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2096 RYAN RD",
            "city": "BUCKLEY",
            "state": "WA",
            "postal_code": "983219115",
            "telephone_number": "360-829-6304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 RYAN RD",
            "city": "BUCKLEY",
            "state": "WA",
            "postal_code": "983219115",
            "telephone_number": "360-829-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUBBUCK",
        "first_name": "JIMMY",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2012-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "20387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather S Campbell, RN
• Stacy Lynn Cargill, LPN
• Leah K Carthum
• Lisa Marie Charette, FNP
• Javaid Chaudhry, DDS
• Chucks Drug (Chucks United Drugs)
• City of Buckley (City of Buckley Fire Department)
• CLB Pharmaceutical Resources Inc (CLB Healthcare Resources)
• Jennifer Cochrane-Nicolls, M.S.W.
• Clare Elizabeth Coetzer, ARNP, LICSW

• Family Medicine Physician in Buckley, WA
• Providers in Buckley, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; 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.