NPIMap

Individual provider Active NPI

Kevin Lenelle Chandler, MD

  • Urology Physician
  • Watertown, NY
National Provider Identifier
1689808875
Registry record updated Jan 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
274532 Issued in NY
Practice address
830 Washington St
Watertown, NY 13601-4099
Phone
(803) 318-3004
NPI assigned
May 4, 2009
Last updated
Jan 9, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 125054165 IL
Urology Physician 208800000X 274532 NY Primary

Addresses

Primary practice location

830 Washington St
Watertown, NY 13601-4099

Mailing address

830 Washington St
Watertown, NY 13601-4099
Phone (803) 318-3004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20140716000699 NY Practitioner - Urology 3274758859 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Northwestern University Feinberg Medical School, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Samaritan Medical CenterGroup PAC ID 8123914876, 157 clinicians

Practice addresses (Care Compare)

830 Washington St
Watertown, NY 13601-4034
Phone (315) 785-4000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125054165ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Samaritan Medical Practice, PC Surgery PastSince Mar 13, 2011 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kchandler@hiemail.healtheconnections.org
  • Direct secure messaging: kevin.chandler@sfhcny.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Samaritan Medical CenterWatertown, NY, CCN 330157 Hospital Corporate Director Jan 1, 2022
Samaritan Medical CenterWatertown, NY, CCN 33T157 Hospital Corporate Director Jan 1, 2023

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1241395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578528000000",
    "number": "1689808875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014099",
            "telephone_number": "803-318-3004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 WASHINGTON ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136014099",
            "telephone_number": "803-318-3004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANDLER",
        "first_name": "KEVIN",
        "middle_name": "LENELLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-04",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125054165",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "274532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

Verify at the official NPI Registry.