Individual provider Active NPI

Ian Charlston Sim Chua, MD

  • Hospitalist Physician
  • Palo Alto, CA
National Provider Identifier
1629393830
Registry record updated Apr 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
A117682 Issued in CA
Practice address
725 Welch Rd
Palo Alto, CA 94304-1601
Phone
(650) 497-8000
NPI assigned
Mar 30, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A117682 CA
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X A117682 CA Primary

Addresses

Primary practice location

725 Welch Rd
Palo Alto, CA 94304-1601

Mailing address

1836 Barossa Dr
San Ramon, CA 94582-4675
Phone (650) 776-9456

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, DC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20130520000689 CA Practitioner - Pediatric MedicinePractitioner - Other (Physician) 9234377821 Reassigns benefits to 3 organizations
I20170510001449 DC Practitioner - Pediatric Medicine 9234377821 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Hospital Pediatrics CurrentSince Mar 14, 2017 Accepting new patients
County of Santa Clara Pediatrics Current Accepting new patients
County of Santa Clara Current Accepting new patients
County of Santa Clara CurrentSince Nov 1, 2019 Accepting new patients
Children's Hospital CurrentSince Mar 14, 2017 Accepting new patients
County of Santa Clara CurrentSince Nov 1, 2019 Accepting new patients
County of Santa Clara CurrentSince Nov 1, 2019 Accepting new patients
Children's Hospital Current Accepting new patients
County of Santa Clara CurrentSince Nov 1, 2019 Accepting new patients

Locations

7475 Camino Arroyo
Gilroy, CA 95020
Phone (408) 852-2400

1993 McKee Rd
San Jose, CA 95116
Phone (408) 254-6320

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

2101 Alexian Dr
San Jose, CA 95116
Phone (408) 272-6050

750 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-2320

500 Tully Rd
San Jose, CA 95111
Phone (408) 817-1433

1996 Lundy Ave
San Jose, CA 95131
Phone (408) 299-5846

300 Pasteur Dr
Stanford, CA 94305
Phone (650) 498-5710

660 S Fair Oaks Ave
Sunnyvale, CA 94086
Phone (408) 885-7366

111 Michigan Ave NW
Washington, DC 20010
Phone (202) 476-3670

Interoperability endpoints

  • Direct secure messaging: ichua6174@santaclaravalley.direct-ci.net

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1269907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714262400000",
    "number": "1629393830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 BAROSSA DR",
            "city": "SAN RAMON",
            "state": "CA",
            "postal_code": "945824675",
            "telephone_number": "650-776-9456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUA",
        "first_name": "IAN CHARLSTON",
        "middle_name": "SIM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-03-30",
        "last_updated": "2024-04-28",
        "certification_date": "2024-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A117682",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A117682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palo Alto, CA

Sources for this page

Verify at the official NPI Registry.