Kenneth Chan, D.O.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

E-0805 Issued in AR

Practice address

4802 E Johnson Ave
Jonesboro, AR 72401-8413

Phone

(870) 936-8000

Fax

(870) 934-3635

NPI assigned

Apr 13, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in AR

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

Specialty

Neurology

Education

Nova Southeastern College of Osteo Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Arkansas Clinic Charitable Foundation, Inc.Group PAC ID 2961547526, 294 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Memorial Hospital Jonesboro, Inc. Hospital, Jonesboro, AR, CCN 040118
• St Bernards Medical Center Hospital, Jonesboro, AR, CCN 040020

Merit-based Incentive Payment System (MIPS)

Final score

75.65 of 100Reported as group

Quality

44.87

Promoting interoperability

100

Improvement activities

40

Cost

73.98

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kchan29535@direct.bmhcc.org

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.

• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Clinic

  • Multi-Specialty Clinic/Center
  • Jonesboro, AR
  • NPI 1861721839
  Medicare reassignment Care Compare group NPD
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Mobile Health Unit

  • Mobile Mammography Clinic/Center
  • Jonesboro, AR
  • NPI 1417721689
  NPD
• Northeast Arkansas Clinic Charitable Foundation, Inc.

  dba NEA Baptist Clinic

  • Clinical Medical Laboratory
  • Jonesboro, AR
  • NPI 1801127030
  NPD
• Northeast Arkansas Clinic, PA

  dba NEA Clinic

  • Multi-Specialty Clinic/Center
  • Jonesboro, AR
  • NPI 1376517177
  NPD (past)
• Northeast Arkansas Health System LLC

  dba NEA Medical Center

  • Cardiovascular Specialist/Technologist
  • Jonesboro, AR
  • NPI 1750322087
  NPD (past)
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641

  Neurology

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Memorial Hospital-Jonesboro Inc

  dba NEA Baptist Memorial Hospital

  • General Acute Care Hospital
  • Jonesboro, AR
  • NPI 1386699353
  Care Compare affiliation
• St Bernards Hospital Inc

  dba St Bernards Medical Center

  • General Acute Care Hospital
  • Jonesboro, AR
  • NPI 1922043686
  Care Compare affiliation

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451865600000",
    "number": "1720042138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1960",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031960",
            "telephone_number": "870-936-8000",
            "fax_number": "870-934-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4802 E JOHNSON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724018413",
            "telephone_number": "870-936-8000",
            "fax_number": "870-934-3635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "KENNETH",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2016-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "AR",
            "license": "E-0805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129976003",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cally Chalker
• Cory Dale Chamberlain
• Cara Chamberlin, MSOT
• Cheryl Chambers
• Camille C Chan, D.O.
• Traci Marie Chance
• Nickolas Aaron Chancery
• Madison Chandler
• Bailey Chapman
• Courtney N Chapman

• Neurology Physician in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Neurology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.