NPIMap

Individual provider Active NPI

Carly Hannah Chamberlain

  • Family Medicine Physician
  • Wilmington, DE
National Provider Identifier
1689134686
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C2-0024178 Issued in DE
Practice address
501 W 14TH St
Wilmington, DE 19801-1013
Phone
(302) 320-4410
Fax
(302) 428-4078
NPI assigned
Mar 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X C2-0024178 DE
Family Medicine Physician 207Q00000X C2-0024178 DE Primary

Addresses

Primary practice location

501 W 14TH St
Wilmington, DE 19801-1013

Mailing address

501 W 14TH St
Wilmington, DE 19801-1013
Phone (302) 320-4410

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240325000528 DE Practitioner - Family PracticePractitioner - Sports Medicine 1456688654 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

1401 Foulk Rd
Suite 100B
Wilmington, DE 19803-2764
Phone (302) 477-3300

Hospital & facility affiliations

  • Bayada Home Health Care, Inc Home health agency, Wilmington, DE, CCN 087021
  • Christiana Hospital Hospital, Newark, DE, CCN 080001

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services, Inc Current Accepting new patients
Christiana Care Health Services Inc Family Medicine CurrentSince Mar 12, 2024 Accepting new patients
Christiana Care Health Services, Inc Family Medicine CurrentSince Mar 12, 2024 Accepting new patients
Christiana Care Health Services Inc CurrentSince Mar 12, 2024 Accepting new patients
Christiana Care Health Services, Inc Family Medicine Past Accepting new patients

Locations

501 W 14th St
Fl Ctr
Wilmington, DE 19801

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

501 W 14th St
Wilmington, DE 19801
Phone (302) 320-4411

Organizations & group practices 28

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.

View all 28

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": "1553472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1689134686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 W 14TH ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198011013",
            "telephone_number": "302-320-4410",
            "fax_number": "302-428-4078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 W 14TH ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198011013",
            "telephone_number": "302-320-4410",
            "fax_number": "302-428-4078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMBERLAIN",
        "first_name": "CARLY",
        "middle_name": "HANNAH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-25",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "DE",
            "license": "C2-0024178",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "DE",
            "license": "C2-0024178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

Verify at the official NPI Registry.