Ronald M Chase, M.D. – Forensic Psychiatry Physician

Key facts

NPI: 1497948996
Entity type: Individual (NPI type 1)
Primary specialty: Forensic Psychiatry Physician 2084F0202X
License: ME23083 (FL)
Practice address: 32910 Lakeshore Dr
Tavares, FL 32778-5013
Phone: (917) 208-5366
NPI assigned: Aug 20, 2007
Sex: Male
Sole proprietor: Yes

Organizations & group practices 1

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.

Lifestream Behavioral Center Inc Primary Care Clinic/Center · Leesburg, FL · NPI 1659613776

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

Practice roles

Organization	Specialty	Status	New patients
Lifestream Behavioral Center Inc		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Forensic Psychiatry Physician	2084F0202X	ME23083	FL	Yes

Addresses

Primary practice location

32910 Lakeshore Dr
Tavares, FL 32778-5013

Mailing address

32910 Lakeshore Dr
Tavares, FL 32778-5013
Phone (917) 208-5366

Other identifiers

Identifier	Type	State	Issuer
N/A	Other		NONE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 10, 2016.

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478736000000",
    "number": "1497948996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32910 LAKESHORE DR",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327785013",
            "telephone_number": "917-208-5366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32910 LAKESHORE DR",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327785013",
            "telephone_number": "917-208-5366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHASE",
        "first_name": "RONALD",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-20",
        "last_updated": "2016-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084F0202X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Forensic Psychiatry",
            "state": "FL",
            "license": "ME23083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "N/A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tavares, FL

All providers in Tavares, FL · Forensic Psychiatry Physician in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.