NPIMap

Organization Active NPI

Chesnut MD

  • Dermatology Physician
  • Spokane, WA
National Provider Identifier
1437798568
Registry record updated Dec 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
CHESNUT MD
Practice address
510 S Cowley St Ste 201
Spokane, WA 99202-1332
Phone
(509) 252-1299
NPI assigned
Jan 6, 2020
Last updated
Dec 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2024

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

Authorized official

Name
Kimbra Crawford
Title
Billing Supervisor
Phone
(509) 413-0008

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
Dermatopathology Physician 207ND0900X NU
Clinical & Laboratory Dermatological Immunology Physician 207NI0002X NU
Pediatric Dermatology Physician 207NP0225X NU
Procedural Dermatology Physician 207NS0135X NU
Otolaryngology Physician 207Y00000X NU
Facial Plastic Surgery Physician 207YS0123X NU
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X NU
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X NU
Plastic Surgery Physician 208200000X NU

Addresses

Primary practice location

510 S Cowley St Ste 201
Spokane, WA 99202-1332

Mailing address

510 S Cowley St Ste 201
Spokane, WA 99202-1332
Phone (509) 252-1299

Other identifiers 2

IdentifierTypeStateIssuer
1598181828MedicaidUT
1952636672MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200414002719 WA Part B Supplier - Clinic/Group Practice 6002246188 Receives reassigned benefits from 15 practitioners
Practice locations: Spokane, WA
O20230313000913 WA DME Supplier - Physician - Dermatology 6002246188 Practice locations: Spokane, WA

National Provider Directory

National Provider Directory

Locations

1334 N Whitman Ln
Ste 200
Liberty Lake, WA 99019

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1578268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734912000000",
    "number": "1437798568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 S COWLEY ST STE 201",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021332",
            "telephone_number": "509-252-1299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 S COWLEY ST STE 201",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992021332",
            "telephone_number": "509-252-1299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHESNUT MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-06",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "KIMBRA",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "509-413-0008"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1598181828",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952636672",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.