Individual provider Active NPI

Connie Chan, MD

  • Internal Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1740252584
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
30337 Issued in AZ
Practice address
4530 E Muirwood Dr
Suite 105
Phoenix, AZ 85048-7639
Phone
(480) 961-2303
Fax
(480) 961-0419
NPI assigned
Feb 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 30337 AZ Primary

Addresses

Primary practice location

4530 E Muirwood Dr
Suite 105
Phoenix, AZ 85048-7639

Mailing address

4530 E Muirwood Dr
Suite 105
Phoenix, AZ 85048-7639
Phone (480) 961-2303

Other identifiers 3

IdentifierTypeStateIssuer
AW2081OtherAZHEALTHNET
AZ0719390OtherAZBLUE CROSS AND BLUE SHIEL
715302MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20180618003345 AZ Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 0648377747

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Pharmacy Services LLC Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1740252584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 E MUIRWOOD DR",
            "address_2": "SUITE 105",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850487639",
            "telephone_number": "480-961-2303",
            "fax_number": "480-961-0419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 E MUIRWOOD DR",
            "address_2": "SUITE 105",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850487639",
            "telephone_number": "480-961-2303",
            "fax_number": "480-961-0419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "CONNIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-06",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "30337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "AW2081",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "AZ0719390",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "715302",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.