Active NPI
Merrill A Chandler, MD
- Emergency Medicine Physician
- Castro Valley, CA
National Provider Identifier
1508847237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- G50134
- Practice address
- 20103 Lake Chabot Rd
Castro Valley, CA 94546-5341 - Phone
- (209) 342-2300
- Fax
- (209) 524-4240
- NPI assigned
- Nov 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | G50134 | CA | Primary |
Addresses
Primary practice location
20103 Lake Chabot Rd
Castro Valley, CA 94546-5341
Mailing address
4301 Northstar Way
Modesto, CA 95356-9262
Phone (209) 342-2300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G501340 | Medicaid | CA | |
| 00G501340 | Other | CA | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G50134 | CA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eden Emergency Medical Group Inc | Emergency Medicine | Current | Accepting new patients |
| Eden Medical Center/San Leandro Hospital Campus | Past | Accepting new patients |
Locations
20103 Lake Chabot Rd
Hayward, CA 94546
Phone (510) 537-1234
4301 N Star Way
Modesto, CA 95356
Phone (915) 521-2290
Organizations & group practices 2
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.
-
- Emergency Medicine Physician
- Castro Valley, CA
- NPI 1891786240
-
- Rehabilitation Hospital Unit
- San Leandro, CA
- NPI 1679523633
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184630400000",
"number": "1508847237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4301 NORTHSTAR WAY",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569262",
"telephone_number": "209-342-2300",
"fax_number": "209-524-4240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20103 LAKE CHABOT RD",
"city": "CASTRO VALLEY",
"state": "CA",
"postal_code": "945465341",
"telephone_number": "209-342-2300",
"fax_number": "209-524-4240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANDLER",
"first_name": "MERRILL",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-09",
"last_updated": "2007-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CA",
"license": "G50134",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G501340",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00G501340",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Castro Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; 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.