Individual provider Active NPI

Carolyn Chu, M.D.

  • Family Medicine Physician
  • New York, NY
National Provider Identifier
1396967055
Registry record updated Jan 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
240265 Issued in NY
Practice address
645 10TH Ave
Ryan/Chelsea-Clinton Community Health Center
New York, NY 10036-2904
Phone
(212) 265-4500
Fax
(212) 265-6565
NPI assigned
May 3, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 19, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 240265 NY Primary

Addresses

Primary practice location

645 10TH Ave
Ryan/Chelsea-Clinton Community Health Center
New York, NY 10036-2904

Mailing address

645 10TH Ave
Ryan/Chelsea-Clinton Community Health Center
New York, NY 10036-2904
Phone (212) 265-4500

Other names 1

  • Ms. Carolyn Chu Other name

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
I20150428001977 CA Practitioner - Family Practice 9739271594 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56201CAMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
City & County of San Francisco Current Accepting new patients
City and County of San Francisco CurrentSince Nov 12, 2019 Accepting new patients
University of California SFGH Medical Group CurrentSince Feb 15, 2015 Accepting new patients
City & County of San Francisco CurrentSince Nov 12, 2019 Accepting new patients
University of California SFGH Medical Group Current Accepting new patients
University of California SFGH Medical Group Family Medicine CurrentSince Feb 15, 2015 Accepting new patients
Montefiore Medical Center Past Accepting new patients
Montefiore Medical Center Past Accepting new patients

Locations

1001 Potrero Ave
Bldg 80
San Francisco, CA 94110
Phone (628) 206-8610

1001 Potrero Ave
San Francisco, CA 94110
Phone (415) 206-2305

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": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326931200000",
    "number": "1396967055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 10TH AVE",
            "address_2": "RYAN/CHELSEA-CLINTON COMMUNITY HEALTH CENTER",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100362904",
            "telephone_number": "212-265-4500",
            "fax_number": "212-265-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 10TH AVE",
            "address_2": "RYAN/CHELSEA-CLINTON COMMUNITY HEALTH CENTER",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100362904",
            "telephone_number": "212-265-4500",
            "fax_number": "212-265-6565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHU",
        "first_name": "CAROLYN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2012-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "240265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "CHU",
            "prefix": "MS.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.