NPIMap

Individual provider Active NPI

Chantel Brook Eckland Johnson, DMD

  • Dentist
  • Nampa, ID
National Provider Identifier
1407546864
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D-5641 Issued in ID
Practice address
207 1St St S
Nampa, ID 83651-3703
Phone
(208) 466-7869
NPI assigned
May 9, 2023
Last updated
Jul 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D-5641 ID Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

207 1St St S
Nampa, ID 83651-3703

Mailing address

PO Box 9
Nampa, ID 83653-0009
Phone (208) 467-4431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240729004626 ID Practitioner - Dentist 3375080187 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Clinics, Inc. CurrentSince Jul 22, 2024 Accepting new patients
Community Health Clinics, Inc. Current Accepting new patients
Community Health Clinics, Inc. CurrentSince Jul 22, 2024 Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients

Locations

150 2nd St
Melba, ID 83641
Phone (208) 495-1011

207 1st St S
Nampa, ID 83651
Phone (208) 318-1376

Interoperability endpoints

  • Direct secure messaging: cecklandjohnson723163@direct.ochin.org

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1683590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1407546864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836530009",
            "telephone_number": "208-467-4431",
            "fax_number": "208-466-5359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 1ST ST S",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836513703",
            "telephone_number": "208-466-7869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ECKLAND JOHNSON",
        "first_name": "CHANTEL",
        "middle_name": "BROOK",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-09",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-5641",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nampa, ID

Sources for this page

Verify at the official NPI Registry.