Keith B Churchwell, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

054404 Issued in CT

Practice address

20 York St
Tompkins 106
New Haven, CT 06510-3220

Phone

(615) 688-2610

NPI assigned

Aug 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Yale University

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236
  Medicare reassignment NPD
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962
  NPD
• Yale New Haven Hospital

  • General Acute Care Hospital
  • New Haven, CT
  • NPI 1336139500
  NPD (past)
• Vanderbilt University Medical Center

  • Internal Medicine Physician
  • Nashville, TN
  • NPI 1104202761
  NPD (past)

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466726400000",
    "number": "1336151273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 YORK ST",
            "address_2": "TOMPKINS 106",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103220",
            "telephone_number": "203-688-2610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 YORK ST",
            "address_2": "TOMPKINS 106",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103220",
            "telephone_number": "615-688-2610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCHWELL",
        "first_name": "KEITH",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2016-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CT",
            "license": "054404",
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TN",
            "license": "25554",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3083503",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Juyeon Chung, PA-C
• Keun Sam Chung, MD
• Shang Lin L Chung
• Young in Chung
• Geoffrey Lal Chupp, MD
• Natela Churgulia, MD
• James P Cianciolo
• John Mark Cianciolo
• Michael Cianciulli, RPT
• Alivia Ciarcia

• Cardiovascular Disease Physician in New Haven, CT
• Providers in New Haven, CT by specialty
• Cardiovascular Disease Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.