NPIMap

Individual provider Active NPI

Christian Nicholas Chan, MD

  • Surgery Physician
  • Las Vegas, NV
National Provider Identifier
1649704172
Registry record updated Jun 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A175539 Issued in CA
Practice address
1111 Shadow LN
Las Vegas, NV 89102-2314
Phone
(702) 383-4040
NPI assigned
Apr 11, 2017
Last updated
Jun 5, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A175539 CA Primary

Addresses

Primary practice location

1111 Shadow LN
Las Vegas, NV 89102-2314

Mailing address

1111 Shadow LN
Las Vegas, NV 89102-2314
Phone (702) 383-4040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220805000487 CA Practitioner - General Surgery 7214296060 Reassigns benefits to 1 organization
I20230808003365 NV Practitioner - General Surgery 7214296060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Loma Linda University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lewis and Lovett LTDGroup PAC ID 4082695069, 6 clinicians

Practice addresses (Care Compare)

7200 Cathedral Rock Dr
Suite 250
Las Vegas, NV 89128-0440
Phone (702) 383-4040

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)12
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Varicose vein removal1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A175539CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lewis & Lovett, LTD CurrentSince Jul 5, 2023 Accepting new patients
Community Health Partners CurrentSince Oct 31, 2022 Accepting new patients
Fresno Community Hospital and Medical Center Past Accepting new patients
Dignity Health Past Accepting new patients
Desert Springs Hospital Past Accepting new patients
Barton Healthcare System Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients
Talbert Medical Group PastSince Jul 5, 2023 Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients

Locations

45 E River Park Pl W
Ste 104
Fresno, CA 93720
Phone (559) 573-3430

2335 E Kashian Ln
Ste 270
Fresno, CA 93701
Phone (559) 445-1251

205 E River Park Cir
Ste 460
Fresno, CA 93720
Phone (559) 261-4500

7200 Cathedral Rock Dr
Ste 250
Las Vegas, NV 89128
Phone (702) 383-4040

1111 Shadow Ln
Las Vegas, NV 89102
Phone (702) 383-4040

Interoperability endpoints

  • Direct secure messaging: christian.chan.1@30569.direct.athenahealth.com
  • Direct secure messaging: cchan196640@direct.renown.org

Organizations & group practices 10

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 6

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": "1491868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1649704172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 SHADOW LN",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022314",
            "telephone_number": "702-383-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 SHADOW LN",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022314",
            "telephone_number": "702-383-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "CHRISTIAN",
        "middle_name": "NICHOLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-11",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A175539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.