NPIMap

Individual provider Active NPI

Chan M Ma, MD

  • Nephrology Physician
  • New York, NY
National Provider Identifier
1487642120
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
180042 Issued in NY
Practice address
128 Mott St
Suite 405
New York, NY 10013-5540
Phone
(212) 966-0068
Fax
(212) 966-0072
NPI assigned
Oct 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 180042 NY Primary

Addresses

Primary practice location

128 Mott St
Suite 405
New York, NY 10013-5540

Mailing address

7705 Shore Road
Brooklyn, NY 11209
Phone (718) 715-8674

Other identifiers 1

IdentifierTypeStateIssuer
01608846MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cma55041@PIKEVILLEKYDIRECT.ORG Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, KY, MT3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040709001296 NY Practitioner - NephrologyPractitioner - Internal Medicine 8325026917 Reassigns benefits to 2 organizations
I20220701002373 KY Practitioner - Nephrology 8325026917 Reassigns benefits to 2 organizations
I20230523001758 MT Practitioner - Nephrology 8325026917 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

128 Mott St
New York, NY 10013-5540
Phone (212) 966-0068

613 23Rd St
Suite 510
Ashland, KY 41101-2878
Phone (606) 329-9335

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
SCL Health Medical Group - Billings, LLC CurrentSince May 15, 2023 Accepting new patients
Cayuga Medical Associates, PC CurrentSince Jan 20, 2024 Accepting new patients
Kings Daughters Medical Specialties Inc CurrentSince Jun 20, 2022 Accepting new patients
Pikeville Medical Center Inc. CurrentSince Mar 17, 2025 Accepting new patients
Kings Daughters Medical Specialties Inc Nephrology CurrentSince Jun 20, 2022 Accepting new patients
Pikeville Medical Center Inc CurrentSince Mar 17, 2025 Accepting new patients
Premier Renal Care, P.C. Nephrology CurrentSince Sep 1, 2006 Accepting new patients
SCL Health Medical Group - Billings LLC CurrentSince May 15, 2023 Accepting new patients
Kings Daughters Medical Specialties Inc Current Accepting new patients
Life Care Nephrology Group L.L.P Nephrology Past Accepting new patients
Island Medical Specialists, P.L.L.C. PastSince Dec 13, 2022 Accepting new patients
Beth Israel Medical Center - Professional Services Past Accepting new patients

Locations

613 23rd St
Ste 510
Ashland, KY 41101

2201 Lexington Ave
Ashland, KY 41101
Phone (606) 268-2560

184 S Mayo Trl
Pikeville, KY 41501
Phone (606) 430-2213

2900 12th Ave N
Ste 400E
Billings, MT 59101
Phone (406) 238-6650

16 N Miles Ave
Hardin, MT 59034
Phone (406) 665-2205

6402 8th Ave
Ste 502
Brooklyn, NY 11220
Phone (718) 567-8810

310 Taughannock Blvd
Fl 4
Ithaca, NY 14850
Phone (607) 269-0100

313 E 18th St
Bsmt
New York, NY 10003

128 Mott St
Ste 405
New York, NY 10013
Phone (212) 966-0068

128 Mott St
New York, NY 10013
Phone (212) 732-0073

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: cma55041@pikevillekydirect.org

Organizations & group practices 12

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 11

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": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1487642120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7705 SHORE ROAD",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11209",
            "telephone_number": "718-715-8674",
            "fax_number": "212-966-0072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 MOTT ST",
            "address_2": "SUITE 405",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100135540",
            "telephone_number": "212-966-0068",
            "fax_number": "212-966-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MA",
        "first_name": "CHAN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-06",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "180042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01608846",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cma55041@PIKEVILLEKYDIRECT.ORG",
            "affiliation": "N",
            "endpointDescription": "Direct Address for CCDA",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Messaging Functionally",
            "address_1": "184 S Mayo Trl",
            "city": "Pikeville",
            "state": "KY",
            "country_code": "US",
            "postal_code": "415011518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.