NPIMap

Individual provider Active NPI

Chalice Ann Addis, FNP-BC

  • Family Nurse Practitioner
  • Lakeport, CA
National Provider Identifier
1306359146
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP95007969 Issued in CA
Practice address
925 Bevins CT
Lakeport, CA 95453-9754
Phone
(707) 263-8382
Fax
(707) 263-1909
NPI assigned
Nov 15, 2017
Last updated
Aug 1, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP95007969 CA Primary

Addresses

Primary practice location

925 Bevins CT
Lakeport, CA 95453-9754

Mailing address

PO Box 1950
Lakeport, CA 95453-1950
Phone (707) 263-8382

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171127003137 CA Practitioner - Nurse Practitioner 8527325695 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

925 Bevins CT
Lakeport, CA 95453-9754
Phone 70726383821204

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.74 of 100Reported as group
Quality
94
Promoting interoperability
92
Improvement activities
40
Cost
65.12

Merit-based Incentive Payment System (MIPS)

Final score
96.74 of 100Reported as group
Quality
80.2
Promoting interoperability
100
Improvement activities
40
Cost
76.39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP95007969CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lake County Tribal Health Southshore Clinic CurrentSince Oct 7, 2024 Accepting new patients
Sutter Bay Hospitals CurrentSince Jan 20, 2020 Accepting new patients
Sutter Bay Hospitals Current Accepting new patients
Sutter Bay Hospitals CurrentSince Jan 20, 2020 Accepting new patients
Lake County Tribal Health Consortium Inc. Current Accepting new patients

Locations

14440 Olympic Dr
Clearlake, CA 95422
Phone (707) 263-8382

5176 Hill Rd E
Lakeport, CA 95453
Phone (707) 262-5000

925 Bevins Ct
Lakeport, CA 95453
Phone (707) 263-8382

987 Parallel Dr
Ste C
Lakeport, CA 95453
Phone (707) 262-5000

Interoperability endpoints

  • Direct secure messaging: caddis535715@hisp.ehr.sutterhealth.org
  • Direct secure messaging: chalice.addis.p1@direct.lcthc.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1510704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1306359146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1950",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954531950",
            "telephone_number": "707-263-8382",
            "fax_number": "707-263-1909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 BEVINS CT",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954539754",
            "telephone_number": "707-263-8382",
            "fax_number": "707-263-1909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDIS",
        "first_name": "CHALICE",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-15",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95007969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeport, CA

Sources for this page

Verify at the official NPI Registry.