Mara Beatriz Chavolla-Calderon, MD

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

License

274120 Issued in NY

Practice address

4802 10TH Ave
Brooklyn, NY 11219-2916

Phone

(718) 283-8854

Fax

(718) 635-6331

NPI assigned

May 15, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: marachavollacalderon@mai.allscriptsdirect.net

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.

• Brookdale Hospital Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1720028772
  Medicare reassignment NPD
• Maimonides Faculty Practice Plan

  • Internal Medicine Physician
  • Brooklyn, NY
  • NPI 1053344846
  Medicare reassignment NPD
• MMC Pediatrics Faculty Practice

  • Pediatrics Physician
  • Brooklyn, NY
  • NPI 1285648154
  Medicare reassignment NPD
• Maimonides Medical Center

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1093777492
  NPD
• The Brookdale Hospital Medical Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Brooklyn, NY
  • NPI 1639756406
  NPD

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

{
    "created_epoch": "1242345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1487889747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 LIBERTY ST APT 35F",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100051553",
            "telephone_number": "646-852-6547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 10TH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112192916",
            "telephone_number": "718-283-8854",
            "fax_number": "718-635-6331"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Mario Capecchi Dr",
            "address_2": "3rd Floor",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841131103",
            "country_code": "US",
            "telephone_number": "801-662-3645",
            "fax_number": "901-662-3664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAVOLLA-CALDERON",
        "first_name": "MARA",
        "middle_name": "BEATRIZ",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-15",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "UT",
            "license": "7192637-1205",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "NY",
            "license": "274120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Chavez
• Sebastian Paul Chavez, MHC
• Mallory Chavis
• Tierra Chavis, MHC
• Michelle Chavkin, PSYD
• Chavrusa Match
• Chavrusa Match
• Chavrusa Match
• Pavida Chaweebong
• Edvic Chawki

• Pediatric Critical Care Medicine Physician in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Pediatric Critical Care Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.