Individual provider Active NPI

Doris Marilu Chavez, MD

  • Family Medicine Physician
  • Bronx, NY
National Provider Identifier
1316101124
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
279186-1 Issued in NY
Practice address
1436 Williamsbridge Rd
Bronx, NY 10461-2507
Phone
(646) 759-5453
Fax
(646) 374-4940
NPI assigned
Jul 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X S7405 TX
Family Medicine Physician 207Q00000X MD2011-0563 NM
Family Medicine Physician 207Q00000X 58349 AZ
Family Medicine Physician 207Q00000X 35.140675 OH
Family Medicine Physician 207Q00000X 812 FL
Family Medicine Physician 207Q00000X 279186-1 NY Primary

Addresses

Primary practice location

1436 Williamsbridge Rd
Bronx, NY 10461-2507

Mailing address

PO Box 26666
PHS Provider Enrollment
Albuquerque, NM 87125-6666
Phone (505) 923-6770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, NY, TX3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20111107000823 NM Practitioner - Family Practice 9537332572 Reassigns benefits to 1 organization
I20160104001374 NY Practitioner - Family Practice 9537332572 Reassigns benefits to 4 organizations
I20201021000945 TX Practitioner - Family Practice 9537332572

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
58349AZMDFamily Medicine Physician
812FLMDFamily Medicine Physician
MD2011-0563NMMDFamily Medicine Physician
279186-1NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Essen Medical Associates, PC CurrentSince Jun 22, 2019 Accepting new patients
Presbyterian Healthcare Services Family Medicine CurrentSince Sep 1, 2016 Accepting new patients
Bronx Medical Practice P.C. CurrentSince Jun 22, 2019 Accepting new patients
Presbyterian Healthcare Services CurrentSince Sep 1, 2016 Accepting new patients
William F Ryan Community Health Center Inc CurrentSince Oct 3, 2015 Accepting new patients
Ryan-Chelsea Clinton Community Health Center CurrentSince Oct 3, 2015 Accepting new patients
Essen Medical Associates, PC CurrentSince Jun 22, 2019 Accepting new patients
William F Ryan Community Health Center Inc CurrentSince Oct 3, 2015 Accepting new patients

Locations

401 San Mateo Blvd SE
Albuquerque, NM 87108
Phone (505) 462-7333

2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577

2015 Grand Concourse
#13202
Bronx, NY 10453

2015 Grand Concourse
Bronx, NY 10453
Phone (718) 294-6200

2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400

1436 Williamsbridge Rd
Bronx, NY 10461
Phone (646) 759-5453

8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400

645 10th Ave
New York, NY 10036
Phone (212) 265-4500

110 W 97th St
New York, NY 10025
Phone (212) 316-7906

Organizations & group practices 8

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": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1316101124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26666",
            "address_2": "PHS PROVIDER ENROLLMENT",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256666",
            "telephone_number": "505-923-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 WILLIAMSBRIDGE RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612507",
            "telephone_number": "646-759-5453",
            "fax_number": "646-374-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAVEZ",
        "first_name": "DORIS",
        "middle_name": "MARILU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-11",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "S7405",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "MD2011-0563",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "58349",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.140675",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "812",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "279186-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.