NPIMap

Individual provider Active NPI

Ted Chung, M.D.

  • Urology Physician
  • Destin, FL
National Provider Identifier
1639148166
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
ME0072919 Issued in FL
Practice address
4012 Commons Dr W
Suite 100
Destin, FL 32541-8422
Phone
(850) 837-0442
Fax
(850) 837-1051
NPI assigned
Mar 16, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X ME0072919 FL Primary

Addresses

Primary practice location

4012 Commons Dr W
Suite 100
Destin, FL 32541-8422

Mailing address

PO Box 936
Shalimar, FL 32579-0936
Phone (850) 837-0442

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20070420000521 FL Practitioner - Urology 5193820066 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Texas Medical School at San Antonio, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4012 Commons Dr W
Suite 100
Destin, FL 32541-8424
Phone (850) 837-0442

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0072919FLMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Urology P a Urology CurrentSince Dec 1, 2006 Accepting new patients
Okaloosa Walton Urology PA Urology Past Accepting new patients
Gulf Coast Gynecology, Inc. Past Accepting new patients
21St Century Oncology LLC Urology Past Accepting new patients

Locations

4012 Commons Dr W
Ste 100
Destin, FL 32541
Phone (850) 837-0442

1823 Hurlburt Rd
Ste 7
Fort Walton Beach, FL 32547
Phone (850) 226-6591

Organizations & group practices 4

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 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": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639148166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 936",
            "city": "SHALIMAR",
            "state": "FL",
            "postal_code": "325790936",
            "telephone_number": "850-837-0442",
            "fax_number": "850-837-1051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4012 COMMONS DR W",
            "address_2": "SUITE 100",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325418422",
            "telephone_number": "850-837-0442",
            "fax_number": "850-837-1051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "TED",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "FL",
            "license": "ME0072919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Destin, FL

Sources for this page

Verify at the official NPI Registry.