Individual provider Active NPI

Chase Atckison, DO

  • Family Medicine Physician
  • Covina, CA
National Provider Identifier
1326576539
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A17432 Issued in CA
Practice address
210 W San Bernardino Rd
Covina, CA 91723-1515
Phone
(626) 331-7331
NPI assigned
Jun 1, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 20A17432 CA Primary

Addresses

Primary practice location

210 W San Bernardino Rd
Covina, CA 91723-1515

Mailing address

981 W Calle del Sol Apt 4
Azusa, CA 91702-1810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20200827000259 CA Practitioner - Family Practice 3476970138 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Hospitalist Network Medical Group IncGroup PAC ID 8921990110, 76 clinicians

Practice addresses (Care Compare)

625 The City Dr S
Suite 320
Orange, CA 92868-4978
Phone (714) 202-2330

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A17432CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Hospitalist Network Medical Group Inc CurrentSince Aug 1, 2020 Accepting new patients

Locations

210 W San Bernardino Rd
Covina, CA 91723
Phone (626) 858-8580

625 The City Dr S
Ste 320
Orange, CA 92868
Phone (714) 202-2330

Organizations & group practices 1

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": "1496275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595980800000",
    "number": "1326576539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "981 W CALLE DEL SOL APT 4",
            "city": "AZUSA",
            "state": "CA",
            "postal_code": "917021810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W SAN BERNARDINO RD",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917231515",
            "telephone_number": "626-331-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATCKISON",
        "first_name": "CHASE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-01",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A17432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.