NPIMap

Individual provider Active NPI

Charlotte Lin Chang, MD

  • Internal Medicine Physician
  • Columbia, MO
National Provider Identifier
1578083515
Registry record updated Aug 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2020008238 Issued in MO
Practice address
900 W Nifong Blvd Ste 101
Columbia, MO 65203-4469
Phone
(573) 499-9009
Fax
(573) 499-4400
NPI assigned
Jun 21, 2017
Last updated
Aug 17, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2020008238 MO Primary
Internal Medicine Physician 207R00000X 2017016768 MO

Addresses

Primary practice location

900 W Nifong Blvd Ste 101
Columbia, MO 65203-4469

Mailing address

900 W Nifong Blvd Ste 101
Columbia, MO 65203-4469
Phone (573) 499-9009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20200515001945 MO Practitioner - Internal Medicine 7618248568 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Washington University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Boone Physician Services LLCGroup PAC ID 6507090644, 243 clinicians

Practice addresses (Care Compare)

900 W Nifong Blvd
Suite 101
Columbia, MO 65203-4469
Phone (573) 815-6640

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2020008238MOMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dedicated Missouri Holding, LLC CurrentSince Apr 1, 2020 Accepting new patients
Boone Physician Services, LLC CurrentSince Aug 16, 2021 Accepting new patients
Dedicated Missouri Holding, LLC PastSince Feb 16, 2020 Accepting new patients

Locations

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1705 E Broadway
Ste 280
Columbia, MO 65201
Phone (573) 815-7119

900 W Nifong Blvd
Ste 101
Columbia, MO 65203
Phone (573) 499-9009

3649 Page Blvd
Saint Louis, MO 63113
Phone (314) 288-0071

Interoperability endpoints

  • Direct secure messaging: charlottechang@mhccaremail.com

Organizations & group practices 3

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 7

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": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1578083515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 W NIFONG BLVD STE 101",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652034469",
            "telephone_number": "573-499-9009",
            "fax_number": "573-499-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W NIFONG BLVD STE 101",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652034469",
            "telephone_number": "573-499-9009",
            "fax_number": "573-499-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "CHARLOTTE",
        "middle_name": "LIN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2021-08-17",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2020008238",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2017016768",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

Verify at the official NPI Registry.