Individual provider Active NPI

Tracy Chiem Hatzopoulos, M.D.

  • Neurology Physician
  • Anaheim, CA
National Provider Identifier
1679701817
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
A125072 Issued in CA
Practice address
Anaheim Kraemer Medical Office 1
3460 East la Palma Avenue
Anaheim, CA 92806
Phone
(888) 988-2800
NPI assigned
Jun 25, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromuscular Medicine (Psychiatry & Neurology) Physician 2084N0008X A125072 CA
Neurology Physician 2084N0400X A125072 CA Primary

Addresses

Primary practice location

Anaheim Kraemer Medical Office 1
3460 East la Palma Avenue
Anaheim, CA 92806

Mailing address

Anaheim Kraemer Medical Office 1
3460 East la Palma Avenue
Anaheim, CA 92806

Other names 1

  • Tracy Chiem Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20140524000190 CA Practitioner - Neurology 6204059033 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A125072CAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Oct 5, 2015 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Jun 30, 2014 Accepting new patients
Healthcare Partners Affiliates Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 5, 2015 Accepting new patients
Healthcare Partners Affiliates Medical Group CurrentSince Jun 30, 2014 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

441 N Lakeview Ave
Anaheim, CA 92807
Phone (714) 279-4000

3460 E La Palma Ave
Ofc 1
Anaheim, CA 92806

5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088

824 E Carson St
Ste 104
Carson, CA 90745
Phone (310) 830-9706

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

Organizations & group practices 6

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": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639440000000",
    "number": "1679701817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ANAHEIM KRAEMER MEDICAL OFFICE 1",
            "address_2": "3460 EAST LA PALMA AVENUE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "92806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ANAHEIM KRAEMER MEDICAL OFFICE 1",
            "address_2": "3460 EAST LA PALMA AVENUE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "92806",
            "telephone_number": "888-988-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATZOPOULOS",
        "first_name": "TRACY",
        "middle_name": "CHIEM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-25",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0008X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neuromuscular Medicine",
            "state": "CA",
            "license": "A125072",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A125072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "441 N Lakeview Ave",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928073028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "CHIEM",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.