NPIMap

Organization Active NPI

Jim C Chiang MD LTD

  • Family Medicine Physician
  • Boulder City, NV
National Provider Identifier
1710161518
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11503 Issued in NV
Legal business name
JIM C CHIANG MD LTD
Practice address
895 Adams Blvd
Boulder City, NV 89005
Phone
(702) 293-0406
Fax
(702) 293-0192
NPI assigned
Dec 28, 2007
Last updated
Aug 30, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
JIM C CHIANG MD LTDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

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

Authorized official

Name
Jim C Chiang, MDNPI 1306816566
Title
MD
Phone
(702) 293-0406

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11503 NV Primary

Addresses

Primary practice location

895 Adams Blvd
Boulder City, NV 89005

Mailing address

895 Adams Blvd
Boulder City, NV 89005
Phone (702) 293-0406

Other identifiers 1

IdentifierTypeStateIssuer
1001507463MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051115000972 NV Part B Supplier - Clinic/Group Practice 9931128378 Receives reassigned benefits from 2 practitioners
Practice locations: Boulder City, NV

National Provider Directory

National Provider Directory
Part of
Jim C Chiang MD LTD

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1198800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1710161518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "895 ADAMS BLVD",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "89005",
            "telephone_number": "702-293-0406",
            "fax_number": "702-293-0192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "895 ADAMS BLVD",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "89005",
            "telephone_number": "702-293-0406",
            "fax_number": "702-293-0192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JIM C CHIANG MD LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JIM C CHIANG MD LTD",
        "enumeration_date": "2007-12-28",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "CHIANG",
        "authorized_official_first_name": "JIM",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "702-293-0406",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "11503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1001507463",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder City, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.