NPIMap

Individual provider Active NPI

Eric Allan Chandley, PA-C, DC

  • Physician Assistant
  • Cornelius, NC
National Provider Identifier
1558307397
Registry record updated Oct 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001000344 Issued in NC
Practice address
19485 Old Jetton Rd Ste 210
Suite 210
Cornelius, NC 28031-6592
Phone
(704) 316-1830
Fax
(704) 316-1835
NPI assigned
Jun 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2389 NC
Physician Assistant 363A00000X 1042 SC
Physician Assistant 363A00000X 001000344 NC Primary

Addresses

Primary practice location

19485 Old Jetton Rd Ste 210
Suite 210
Cornelius, NC 28031-6592

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 316-1830

Other identifiers 1

IdentifierTypeStateIssuer
8102026MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address echandley21091@direct.novanthealth.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060117000947 NC Practitioner - Physician Assistant 3971527953 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
May accept Medicare assignment
Group practices
Comprehab, IncGroup PAC ID 2769653757, 376 clinicians
Novant Health Medical Group, LLCGroup PAC ID 1153234893, shared by 14 NPIs, 2,413 clinicians

Practice addresses (Care Compare)

2675 Court Dr
Gastonia, NC 28054-1478
Phone (704) 824-7800

4741 Randolph Rd
Suite 100And200
Charlotte, NC 28211-2919
Phone (704) 365-6730

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2389NCMDBehavioral Analyst
1042SCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Medical Group, Inc. CurrentSince Apr 1, 2023 Accepting new patients
Carolina Medicorp Enterprises, LLC CurrentSince May 6, 2022 Accepting new patients
Novant Medical Group, Inc. CurrentSince Mar 1, 2012 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Mar 1, 2012 Accepting new patients
Carolina Medicorp Enterprises, LLC CurrentSince May 6, 2022 Accepting new patients
North Carolina Em-1 Medical Services, PC Physician Assistant CurrentSince Nov 3, 2010 Accepting new patients
Fox Mountain Emergency Physicians Past Accepting new patients
Healthmed PC Past Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

4741 Randolph Rd
Ste 100200
Charlotte, NC 28211
Phone (704) 365-6730

9550 Rocky River Rd
Ste 150
Charlotte, NC 28215
Phone (704) 457-1510

19485 Old Jetton Rd
Ste 210
Cornelius, NC 28031
Phone (704) 316-1830

19620 W Catawba Ave
Ste 202
Cornelius, NC 28031
Phone (704) 439-1275

16525 Holly Crest Ln
Ste 150
Huntersville, NC 28078
Phone (704) 384-1725

171 Fairview Rd
Mooresville, NC 28117
Phone (704) 660-4000

612 Mocksville Ave
Salisbury, NC 28144
Phone (704) 210-5000

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

207 Old Lexington Rd
Thomasville, NC 27360
Phone (336) 472-2000

600 Highland Oaks Dr
Winston Salem, NC 27103
Phone (366) 774-0040

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: eric.chandley.1@14389.direct.athenahealth.com
  • Direct secure messaging: echandley21091@direct.novanthealth.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 5

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": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603584000000",
    "number": "1558307397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-316-1830",
            "fax_number": "704-316-1835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19485 OLD JETTON RD STE 210",
            "address_2": "SUITE 210",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280316592",
            "telephone_number": "704-316-1830",
            "fax_number": "704-316-1835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDLEY",
        "first_name": "ERIC",
        "middle_name": "ALLAN",
        "credential": "PA-C, DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2020-10-25",
        "certification_date": "2020-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "2389",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "1042",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001000344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8102026",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "echandley21091@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "19485 Old Jetton Rd Ste 210",
            "address_2": "Suite 210",
            "city": "Cornelius",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280316592",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cornelius, NC

Sources for this page

Verify at the official NPI Registry.