NPIMap

Organization Active NPI

Geeta S Chavda MD PLLC

  • Rural Health Clinic/Center
  • Hopkinsville, KY
National Provider Identifier
1750302865
Registry record updated Feb 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GEETA S CHAVDA MD PLLC
Practice address
1739 Canton St
Hopkinsville, KY 42240-1991
Phone
(270) 881-1411
Fax
(270) 881-4730
NPI assigned
Jul 22, 2006
Last updated
Feb 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2018

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

Authorized official

Name
Dr. Geeta S Chavda, MDNPI 1962477133
Title
Owner
Phone
(270) 881-1411

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

1739 Canton St
Hopkinsville, KY 42240-1991

Mailing address

1739 Canton St
Hopkinsville, KY 42240-1991
Phone (270) 881-1411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060209000548 KY Part B Supplier - Clinic/Group Practice 8628083870 Receives reassigned benefits from 10 practitioners
Practice locations: Hopkinsville, KY
O20170906003985 KY Part A Provider - Rural Health Clinic 8628083870 Practice locations: Hopkinsville, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750302865. Details of each certification follow.

Rural health clinic certification: CCN 188964

Legal name
GEETA S CHAVDA MD PLLC
Doing business as
GEETA CHAVDA MD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 31, 2017
Last certification
Oct 31, 2017
Ownership / control type
1A
Organization structure
OtherProprietary
Incorporated
Dec 20, 2005 in KY
Enrollment address
1739 Canton St
Hopkinsville, KY 42240-1991

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D1003666Geeta Chavda, MD1739 Canton Street, Hopkinsville, KY 42240Certificate of waiverSep 5, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Latisha Edmonds Individual W-2 Managing EmployeeOffice Administrator Aug 1, 2017
Sanjay M Chavda Individual Contracted Managing EmployeeMedical Director Aug 1, 2017
Geeta S Chavda Individual 5% Or Greater Direct Ownership Interest Dec 20, 2005 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 10

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": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519776000000",
    "number": "1750302865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1739 CANTON ST",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422401991",
            "telephone_number": "270-881-1411",
            "fax_number": "270-881-4730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1739 CANTON ST",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422401991",
            "telephone_number": "270-881-1411",
            "fax_number": "270-881-4730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEETA S CHAVDA MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2018-02-28",
        "status": "A",
        "authorized_official_last_name": "CHAVDA",
        "authorized_official_first_name": "GEETA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-881-1411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hopkinsville, KY

Sources for this page

Verify at the official NPI Registry.