Ted Chung, M.D.
Individual provider Active NPI Urology Physician · Destin, FL
NPI 1639148166 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1639148166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Urology Physician 208800000X
- License
- ME0072919 (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
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 5
Medicare Care Compare profile
- 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
- Sacred Heart Hospital on the Emerald Coast
- HCA Florida Fort Walton-Destin Hospital
- HCA Florida Twin Cities Hospital
- Baptist Hospital
- Gulf Breeze Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Prostate resection | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070420000521 | FL | Practitioner - Urology | 5193820066 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0072919 | FL | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Coastal Urology P a | Urology | Current |
Accepting new patients |
| Gulf Coast Gynecology, Inc. | Past | Accepting new patients | |
| Okaloosa Walton Urology PA | Urology | 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | ME0072919 | FL | Yes |
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
Other providers in Destin, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.