Jessica Skold Clark Chandamuri, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD205301 Issued in LA

Practice address

5640 Read Blvd Ste 810
New Orleans East Behavioral Health Clinic
New Orleans, LA 70127-3125

Phone

(504) 243-7600

Fax

(504) 243-7610

NPI assigned

Apr 10, 2009

Last updated

Aug 21, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Jessica Skold Clark Professional name

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Louisiana State University School of Medicine in New Orleans, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Capitol City Family Health Center IncorporatedGroup PAC ID 5193639151, 41 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Capitol City Family Health Center Incorporated

  dba CareSouth

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
  • NPI 1265548614
  Medicare reassignment Care Compare group NPD
• Capitol City Family Health Center, Incorporated

  dba CareSouth

  • Federally Qualified Health Center (FQHC)
  • Baton Rouge, LA
  • NPI 1720965767
  NPD
• Metropolitan Human Services District

  dba Algiers Behavioral Health Clinic

  • Community/Behavioral Health Agency
  • New Orleans, LA
  • NPI 1316166036
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377043200000",
    "number": "1629211305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5640 READ BLVD STE 810",
            "address_2": "NEW ORLEANS EAST BEHAVIORAL HEALTH CLINIC",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701273125",
            "telephone_number": "504-243-7600",
            "fax_number": "504-243-7610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5640 READ BLVD STE 810",
            "address_2": "NEW ORLEANS EAST BEHAVIORAL HEALTH CLINIC",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701273125",
            "telephone_number": "504-243-7600",
            "fax_number": "504-243-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDAMURI",
        "first_name": "JESSICA",
        "middle_name": "SKOLD CLARK",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-10",
        "last_updated": "2013-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "MD205301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1883255",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "CLARK",
            "middle_name": "SKOLD",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Champion Medical Center
• Joneae Champion
• Tyler Champion
• Ashley Chan, PA-C
• Charlene Chan, MD
• Beren Chandler
• Ermine Faye Chandler, C.R.N.A.
• Grace Chandler
• Jonathan Nicholas Chandler, PSYD, MP
• Reginald Michael Chandler

• Psychiatry Physician in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Psychiatry Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.