Individual provider Active NPI

Grace C Chang, MD

  • Anesthesiology Physician
  • Santa Monica, CA
National Provider Identifier
1720024789
Registry record updated Jan 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A95514 Issued in CA
Practice address
2121 Santa Monica Blvd
Santa Monica, CA 90404
Phone
(310) 829-5511
NPI assigned
Jun 20, 2006
Last updated
Jan 3, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A95514 CA Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X A95514 CA

Addresses

Primary practice location

2121 Santa Monica Blvd
Santa Monica, CA 90404

Mailing address

2708 Wilshire Blvd # 248
Santa Monica, CA 90403-4706

Other practice location 1

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598-3122
Phone (925) 947-3779

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
I20070215000700 CA Practitioner - AnesthesiologyPractitioner - Interventional Pain Management 9537163118 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Interventional Pain Management
Education
Boston University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bayside Anesthesia Medical GroupGroup PAC ID 2466490560, 47 clinicians

Practice addresses (Care Compare)

1328 22ND St
St Johns Hospital
Santa Monica, CA 90404-2091
Phone (310) 477-2465

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A95514CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bayside Anesthesia Medical Group Pain Medicine CurrentSince Jan 1, 2019 Accepting new patients

Locations

1328 22nd St
Santa Monica, CA 90404
Phone (310) 829-5511

2121 Santa Monica Blvd
Santa Monica, CA 90404
Phone (310) 281-2024

Organizations & group practices 1

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 1

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": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546473600000",
    "number": "1720024789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2708 WILSHIRE BLVD # 248",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904034706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 SANTA MONICA BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90404",
            "telephone_number": "310-829-5511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1601 Ygnacio Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Walnut Creek",
            "state": "CA",
            "postal_code": "945983122",
            "country_code": "US",
            "telephone_number": "925-947-3779",
            "fax_number": "925-947-3291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANG",
        "first_name": "GRACE",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-20",
        "last_updated": "2019-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A95514",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A95514",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.