Individual provider Active NPI

Myungwon Christine Chang, MD

  • Surgery Physician
  • Indianapolis, IN
National Provider Identifier
1417248477
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
01076534A Issued in IN
Practice address
7250 Clearvista Dr Ste 100
Indianapolis, IN 46256
Phone
(317) 621-5673
NPI assigned
Apr 26, 2011
Last updated
Nov 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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
Surgery Physician 208600000X 01076534A IN Primary

Addresses

Primary practice location

7250 Clearvista Dr Ste 100
Indianapolis, IN 46256

Mailing address

6626 E 75TH St Ste 500
Indianapolis, IN 46250-2890

Other practice location 1

112 Hospital Ln Ste 100
Danville, IN 46122-2600
Phone (317) 745-3740

Other identifiers 1

IdentifierTypeStateIssuer
201359300MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mchang340892@eCommunityDirect.com Community Physicians of Indiana Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20160531001656 IN Practitioner - General Surgery 4587817440 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Wayne State University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians

Practice addresses (Care Compare)

7250 Clearvista Dr
Suite 100
Indianapolis, IN 46256-4640
Phone (317) 621-5673

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux26

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01076534AINMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Surgeons, Inc. Surgery CurrentSince Jul 1, 2016 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Sep 23, 2019 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Sep 23, 2019 Accepting new patients
Hendricks County Hospital Past Accepting new patients
Hendricks County Hospital Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

5819 Reliable Pkwy
Chicago, IL 60686

7630 Solutions Ctr
Chicago, IL 60677

550 University Blvd
Indianapolis, IN 46202
Phone (217) 274-5000

6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547

7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444

7250 Clearvista Dr
Ste 100
Indianapolis, IN 46256
Phone (317) 621-2211

Interoperability endpoints

  • FHIR API: https://sehproxy.stelizabeth.com/arr-fhir/api/FHIR/R4
  • Direct secure messaging: mchang340892@ecommunitydirect.com

Organizations & group practices 6

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 1

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": "1303776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1417248477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6626 E 75TH ST STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462502890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7250 CLEARVISTA DR STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46256",
            "telephone_number": "317-621-5673"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "112 Hospital Ln Ste 100",
            "address_purpose": "LOCATION",
            "city": "Danville",
            "state": "IN",
            "postal_code": "461222600",
            "country_code": "US",
            "telephone_number": "317-745-3740",
            "fax_number": "317-745-3816",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANG",
        "first_name": "MYUNGWON",
        "middle_name": "CHRISTINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-26",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01076534A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201359300",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mchang340892@eCommunityDirect.com",
            "affiliation": "Y",
            "affiliationName": "Community Physicians of Indiana Inc",
            "address_1": "7250 Clearvista Dr Ste 100",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.