NPIMap

Individual provider Active NPI

Wikrom Chaiwatcharayut, M.D.

  • Internal Medicine Physician
  • Ventura, CA
National Provider Identifier
1306259809
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A144707 Issued in CA
Practice address
200 S Wells Rd
Ventura, CA 93004-1377
Phone
(805) 647-6322
Fax
(805) 647-7164
NPI assigned
Jun 3, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A144707 CA Primary
Internal Medicine Physician 207R00000X 2021-02077 NC

Addresses

Primary practice location

200 S Wells Rd
Ventura, CA 93004-1377

Mailing address

1843 Quiet CV
Fayetteville, NC 28304-3857
Phone (910) 483-8080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170801002156 CA Practitioner - Internal Medicine 1658672951 Reassigns benefits to 1 organization
I20210729000763 NC Practitioner - Internal Medicine 1658672951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2012
Medicare assignment
May accept Medicare assignment
Group practices
Village Internal Medicine, PAGroup PAC ID 4880785823, 5 clinicians

Practice addresses (Care Compare)

1843 Quiet CV
Fayetteville, NC 28304-3857
Phone (910) 483-8080

Hospital & facility affiliations

  • Liberty Home Care, LLC Home health agency, Fayetteville, NC, CCN 347249
  • Amedisys Home Health of Fayetteville Home health agency, Fayetteville, NC, CCN 347132
  • Aveanna Home Health Home health agency, Fayetteville, NC, CCN 347241
  • 3HC Home health agency, Goldsboro, NC, CCN 347104
  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A144707CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Village Internal Medicine, PA Internal Medicine CurrentSince Aug 23, 2021 Accepting new patients
Clinicas del Camino Real Inc CurrentSince Aug 1, 2017 Accepting new patients
Clinicas del Camino Real Inc CurrentSince Aug 1, 2017 Accepting new patients
Clinicas del Camino Real Inc Current Accepting new patients
Clinicas del Camino Real Inc Past Accepting new patients
Clinicas del Camino Real Inc Past Accepting new patients

Locations

500 E Main St
Santa Paula, CA 93060
Phone (805) 933-0895

200 S Wells Rd
Ventura, CA 93004
Phone (805) 647-6322

1843 Quiet Cv
Fayetteville, NC 28304
Phone (910) 323-2626

Interoperability endpoints

  • Direct secure messaging: wikromchaiwatcharayut@vim.allscriptsdirect.net

Organizations & group practices 6

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1306259809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1843 QUIET CV",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043857",
            "telephone_number": "910-483-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S WELLS RD",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930041377",
            "telephone_number": "805-647-6322",
            "fax_number": "805-647-7164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAIWATCHARAYUT",
        "first_name": "WIKROM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-03",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A144707",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2021-02077",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.