Carl W Lange IV, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2014004500 Issued in MO

Practice address

1337 S Sam Houston Blvd
Houston, MO 65483-2046

Phone

(417) 967-5435

Fax

(417) 967-5503

NPI assigned

Feb 14, 2014

Last updated

Feb 14, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mr. Chip Lange IV Other name

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Texas County Memorial Hospital

  dba TCMH Internal Medicine Associates

  • Multi-Specialty Clinic/Center
  • Houston, MO
  • NPI 1306885587
  Medicare reassignment NPD
• Texas County Memorial Hospital

  • General Acute Care Hospital
  • Houston, MO
  • NPI 1790740363
  Medicare reassignment NPD
• Phelps County Regional Medical Center

  dba Phelps Health

  • General Acute Care Hospital
  • Rolla, MO
  • NPI 1891766051
  Medicare reassignment
• Phelps County Regional Medical Center

  dba Phelps Health Medical Group

  • Rural Health Clinic/Center
  • Rolla, MO
  • NPI 1366066037
  NPD
• Texas County Memorial Hospital

  dba TCMH Health Clinic - Annex

  • Clinic/Center
  • Houston, MO
  • NPI 1497593719
  NPD
• Texas County Memorial Hospital

  dba TCMH Internal Medicine

  • Rural Health Clinic/Center
  • Houston, MO
  • NPI 1710004486
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392336000000",
    "number": "1700200458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1337 S SAM HOUSTON BLVD",
            "city": "HOUSTON",
            "state": "MO",
            "postal_code": "654832046",
            "telephone_number": "417-967-5435",
            "fax_number": "417-967-5503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1337 S SAM HOUSTON BLVD",
            "city": "HOUSTON",
            "state": "MO",
            "postal_code": "654832046",
            "telephone_number": "417-967-5435",
            "fax_number": "417-967-5503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANGE",
        "first_name": "CARL",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-14",
        "last_updated": "2014-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2014004500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700200458",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "26D0889777",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHIP",
            "last_name": "LANGE",
            "prefix": "MR.",
            "suffix": "IV",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Jason Matthew Loden, DO
• Teresa Lorraine Loden, D.O.
• Tim Louks, COTA/L

• Physician Assistant in Houston, MO
• Providers in Houston, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.