NPIMap

Individual provider Active NPI

Connie Chan, D.O.

  • Emergency Medicine Physician
  • Monterey Park, CA
National Provider Identifier
1639105745
Registry record updated Feb 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
20A6654 Issued in CA
Practice address
525 N Garfield Ave
Monterey Park, CA 91754-1202
Phone
(626) 307-2129
Fax
(626) 307-2056
NPI assigned
Jun 23, 2006
Last updated
Feb 18, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 20A6654 CA Primary

Addresses

Primary practice location

525 N Garfield Ave
Monterey Park, CA 91754-1202

Mailing address

2405 Rolling Green Dr
Santa Maria, CA 93455-1525
Phone (805) 928-5331

Other identifiers 1

IdentifierTypeStateIssuer
00AX66540MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20040303000484 CA Practitioner - Emergency Medicine 4183511207 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Team Physicians of California Medical Group IncGroup PAC ID 8224945084, 92 clinicians

Practice addresses (Care Compare)

975 S Fairmont Ave
Lodi, CA 95240-5118
Phone (209) 334-3411

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A6654CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California Emergency Medicine Current Accepting new patients
Santa Ynez River Physicians, PC Emergency Medicine CurrentSince Dec 1, 2018 Accepting new patients
Team Physicians of California Medical Group Inc Emergency Medicine CurrentSince Dec 1, 2023 Accepting new patients
Cep America - California Emergency Medicine CurrentSince Jun 1, 2016 Accepting new patients
Cep America-California Emergency Medicine CurrentSince Jun 1, 2016 Accepting new patients
Garfield Emergency Medical Associates, Inc. Emergency Medicine Past Accepting new patients
California Em-I Medical Services Emergency Medicine Past Accepting new patients
Central Coast Emergency Physicians Emergency Medicine Past Accepting new patients

Locations

751 Medical Center Ct
#1182
Chula Vista, CA 91911

975 S Fairmont Ave
Lodi, CA 95240
Phone (209) 339-7575

1515 E Ocean Ave
Lompoc, CA 93436
Phone (805) 737-3300

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1 Medical Plaza Dr
Roseville, CA 95661
Phone (916) 781-1000

7500 Hospital Dr
Sacramento, CA 95823
Phone (916) 423-3000

525 W Acacia St
Stockton, CA 95203
Phone (209) 944-5410

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

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

Hospital & facility affiliations 3

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203292800000",
    "number": "1639105745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2405 ROLLING GREEN DR",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934551525",
            "telephone_number": "805-928-5331",
            "fax_number": "805-928-5331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 N GARFIELD AVE",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917541202",
            "telephone_number": "626-307-2129",
            "fax_number": "626-307-2056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "CONNIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-23",
        "last_updated": "2008-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "20A6654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX66540",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monterey Park, CA

Sources for this page

Verify at the official NPI Registry.