Individual provider Active NPI

Daniel Chase, FNP-C

  • Nurse Practitioner
  • Tupelo, MS
National Provider Identifier
1528830536
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
906320 Issued in MS
Practice address
618 Pegram Dr
Tupelo, MS 38801-6322
Phone
(662) 844-6513
NPI assigned
Oct 23, 2023
Last updated
Oct 23, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 906320 MS Primary

Addresses

Primary practice location

618 Pegram Dr
Tupelo, MS 38801-6322

Mailing address

65 Highway 364
Booneville, MS 38829-8602
Phone (662) 643-8041

Other practice location 1

2907 Highway 72 W
Corinth, MS 38834-9399
Phone (662) 396-4104

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240226001264 MS Practitioner - Nurse Practitioner 7911342332 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ear, Nose and Throat Physicians of North Miss., P.aGroup PAC ID 8729053343, 22 clinicians

Practice addresses (Care Compare)

2907 Hwy 72 W
Corinth, MS 38834-9399
Phone (662) 396-4104

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ear, Nose & Throat Physicians of North Miss., P.a. CurrentSince Jan 13, 2024 Accepting new patients
Premier Radiology, Inc PastSince Oct 29, 2023 Accepting new patients

Locations

2907 Highway 72 W
Corinth, MS 38834
Phone (662) 396-4104

618 Pegram Dr
Tupelo, MS 38801
Phone (601) 841-3000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1698019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1528830536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 HIGHWAY 364",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388298602",
            "telephone_number": "662-643-8041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 PEGRAM DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388016322",
            "telephone_number": "662-844-6513"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2907 Highway 72 W",
            "address_purpose": "LOCATION",
            "city": "Corinth",
            "state": "MS",
            "postal_code": "388349399",
            "country_code": "US",
            "telephone_number": "662-396-4104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHASE",
        "first_name": "DANIEL",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-23",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "906320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.