Individual provider Active NPI

Michelle Ji Hye Chang

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1669008058
Registry record updated Mar 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
360 W Avenue 26 Apt 423
Los Angeles, CA 90031-1490
Phone
(213) 255-8805
NPI assigned
Mar 17, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

360 W Avenue 26 Apt 423
Los Angeles, CA 90031-1490

Mailing address

360 W Avenue 26 Apt 423
Los Angeles, CA 90031-1490
Phone (213) 255-8805

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210319002188 CA Practitioner - Physician Assistant 8325455231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kevin J Pelton MD IncGroup PAC ID 3375625486, 38 clinicians

Practice addresses (Care Compare)

1700 E Cesar Chavez Ave
Suite 2200
Los Angeles, CA 90033-2476

1700 E Cesar E Chavez Ave
Suite 2200
Los Angeles, CA 90033-2476
Phone (323) 264-7600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kevin J. Pelton MD, Inc. CurrentSince Mar 1, 2021 Accepting new patients
Kevin J Pelton MD Inc CurrentSince Mar 1, 2021 Accepting new patients
Kevin J. Pelton MD, Inc. Past Accepting new patients

Locations

1700 E Cesar E Chavez Ave
Ste 2200
Los Angeles, CA 90033
Phone (323) 264-7600

18840 Ventura Blvd
Ste 204
Tarzana, CA 91356
Phone (818) 708-3333

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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": "1584403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1669008058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 W AVENUE 26 APT 423",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900311490",
            "telephone_number": "213-255-8805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 W AVENUE 26 APT 423",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900311490",
            "telephone_number": "213-255-8805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANG",
        "first_name": "MICHELLE",
        "middle_name": "JI HYE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-17",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.