Individual provider Active NPI

Pei Chang Chung, M.D.

  • Surgery Physician
  • Maryville, IL
National Provider Identifier
1669609988
Registry record updated Apr 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036.129090 Issued in IL
Practice address
6810 State Route 162 Ste 100
Maryville, IL 62062-8560
Phone
(618) 288-3616
Fax
(618) 288-3647
NPI assigned
Jun 12, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2020

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 036.129090 IL Primary

Addresses

Primary practice location

6810 State Route 162 Ste 100
Maryville, IL 62062-8560

Mailing address

6810 State Route 162 Ste 100
Maryville, IL 62062-8560
Phone (618) 288-3616

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120316000723 IL Practitioner - General Surgery 7810042827 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians

Practice addresses (Care Compare)

6810 State Route 162
Suite 10
Maryville, IL 62062-8587
Phone (618) 288-2020

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
74.76 of 100Reported as group
Quality
54.98
Promoting interoperability
85
Improvement activities
40
Cost
73.39

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.129090ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Medical Group, LLC Surgery CurrentSince Apr 1, 2020 Accepting new patients
Physician Groups LC Past Accepting new patients

Locations

6810 State Route 162
Ste 10
Maryville, IL 62062
Phone (618) 288-2020

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

6810 State Route 162
Ste 100
Maryville, IL 62062
Phone (618) 288-3616

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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": "1244764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1669609988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162 STE 100",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628560",
            "telephone_number": "618-288-3616",
            "fax_number": "618-288-3647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162 STE 100",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628560",
            "telephone_number": "618-288-3616",
            "fax_number": "618-288-3647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "PEI CHANG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-12",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036.129090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

Verify at the official NPI Registry.