NPIMap

Individual provider Active NPI

Chad Edward Hartley, MD

  • Neurological Surgery Physician
  • Lake Havasu City, AZ
National Provider Identifier
1457513749
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
46605 Issued in AZ
Practice address
72 Lake Havasu Ave S Ste 102
Lake Havasu City, AZ 86403-0857
Phone
(928) 453-2211
Fax
(928) 453-2213
NPI assigned
Jun 27, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 46605 AZ Primary

Addresses

Primary practice location

72 Lake Havasu Ave S Ste 102
Lake Havasu City, AZ 86403-0857

Mailing address

72 Lake Havasu Ave S Ste 102
Lake Havasu City, AZ 86403-0857
Phone (928) 453-2211

Other practice location 1

13677 W McDowell Rd
Goodyear, AZ 85395-2635
Phone (928) 453-2211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20121228000186 AZ Practitioner - Neurosurgery 2365517760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of Colorado School of Medicine, Denver, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Panacea Brain and Spine LLCGroup PAC ID 0648423525, 2 clinicians

Practice addresses (Care Compare)

72 Lake Havasu Ave S
Suite 102
Lake Havasu City, AZ 86403-0857
Phone (928) 453-2211

Hospital & facility affiliations

  • Havasu Regional Medical Center Hospital, Lake Havasu City, AZ, CCN 030069
  • Kingman Regional Medical Center Hospital, Kingman, AZ, CCN 030055
  • La Paz Regional Hospital Hospital, Parker, AZ, CCN 031317
  • Western Arizona Regional Medical Center Hospital, Bullhead City, AZ, CCN 030101
  • Valley View Medical Center Hospital, Fort Mohave, AZ, CCN 030117

Merit-based Incentive Payment System (MIPS)

Final score
78.58 of 100Reported as group
Quality
62.67
Improvement activities
40
Cost
78.37

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion109
Laminectomy or laminotomy (partial removal of spine bones)40

National Provider Directory

National Provider Directory
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

Practice roles

OrganizationSpecialtyStatusNew patients
Panacea Brain and Spine, LLC Current Accepting new patients
Chad Hartley MD Pllcc Neurological Surgery Past Accepting new patients
Havasu Regional Medical Center LLC Past Accepting new patients

Locations

297 Lake Havasu Ave S
Ste 204
Lk Havasu Cty, AZ 86403
Phone (928) 453-1970

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5773/brand/1/csg/1/fhir/r4
  • Direct secure messaging: chad.hartley.1@5773.direct.athenahealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 7

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": "1214524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1457513749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72 LAKE HAVASU AVE S STE 102",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864030857",
            "telephone_number": "928-453-2211",
            "fax_number": "928-453-2219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 LAKE HAVASU AVE S STE 102",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864030857",
            "telephone_number": "928-453-2211",
            "fax_number": "928-453-2213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13677 W McDowell Rd",
            "address_purpose": "LOCATION",
            "city": "Goodyear",
            "state": "AZ",
            "postal_code": "853952635",
            "country_code": "US",
            "telephone_number": "928-453-2211",
            "fax_number": "928-453-2219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARTLEY",
        "first_name": "CHAD",
        "middle_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-27",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "AZ",
            "license": "46605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

Verify at the official NPI Registry.