Carlos Chacon, CRNP
Individual provider Active NPI Family Nurse Practitioner · Boaz, AL
NPI 1477095883 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1477095883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 1131572 (AL)
- Practice address
- 2986 US Highway 431
Boaz, AL 35957-5848 - Phone
- (256) 840-8181
- Fax
- (256) 744-7290
- NPI assigned
- Nov 16, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Rehab Services Group LLC
Practice addresses (Care Compare)
41718 Al Hwy 75
Geraldine, AL 35974-3490
Phone (256) 925-0469
Hospital & facility affiliations
- Marshall Medical Centers
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170922000736 | AL | Practitioner - Nurse Practitioner | 6709150220 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1131572 | AL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehab Services Group LLC | Current |
Accepting new patients | |
| Medical Asset Group, LLC | Current |
Accepting new patients | |
| Medical Asset Group, LLC | Current |
Accepting new patients |
Locations
3442 US Highway 431
Albertville, AL 35950
Phone (256) 593-1234
15239 AL Highway 68
Crossville, AL 35962
Phone (256) 528-7173
41718 AL Highway 75
Geraldine, AL 35974
Phone (256) 925-0469
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1131572 | AL | Yes |
Addresses
Primary practice location
2986 US Highway 431
Boaz, AL 35957-5848
Mailing address
PO Box 697
Boaz, AL 35957-0697
Phone (256) 840-8181
Other practice location 1
3442 US Highway 431
Albertville, AL 35950-0203
Phone (256) 593-1234 ext. 111
Other providers in Boaz, AL
- Anna Campos
- Carole Fuller Edmonds, DMD
- Jenna Carpenter
- Katherine Casey
- Central Alabama Emergency Physicians, LLC
- Mark H Christensen
- Andrew Russell Christie
- Jessica Cieszkowski
- City of Boaz
- Hollie Claburn
All providers in Boaz, AL · Family Nurse Practitioner in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.