Individual provider Active NPI

Chitra V Nadimpalli, MD

  • Ophthalmology Physician
  • Port Arthur, TX
National Provider Identifier
1306816616
Registry record updated Dec 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
036069007 Issued in IL
Practice address
3000 39TH St
Suite 102
Port Arthur, TX 77642-5517
Phone
(409) 985-2569
Fax
(409) 985-2915
NPI assigned
Jan 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 036069007 IL Primary

Addresses

Primary practice location

3000 39TH St
Suite 102
Port Arthur, TX 77642-5517

Mailing address

3000 39TH St
Suite 102
Port Arthur, TX 77642-5517
Phone (409) 985-2569

Other identifiers 1

IdentifierTypeStateIssuer
036069007MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036069007ILMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital &Medical Center Ophthalmology Current Accepting new patients
Wicker Park Eye Center LTD Ophthalmology PastSince Jan 1, 1986 Accepting new patients

Locations

28231 Network Pl
Chicago, IL 60673

2525 S Michigan Ave
Chicago, IL 60616
Phone (312) 355-1153

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1138233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291766400000",
    "number": "1306816616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 39TH ST",
            "address_2": "SUITE 102",
            "city": "PORT ARTHUR",
            "state": "TX",
            "postal_code": "776425517",
            "telephone_number": "409-985-2569",
            "fax_number": "409-985-2915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 39TH ST",
            "address_2": "SUITE 102",
            "city": "PORT ARTHUR",
            "state": "TX",
            "postal_code": "776425517",
            "telephone_number": "409-985-2569",
            "fax_number": "409-985-2915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NADIMPALLI",
        "first_name": "CHITRA",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-26",
        "last_updated": "2010-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036069007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036069007",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Arthur, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; 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.