Individual provider Active NPI

Nicole Tien Chao, MD

  • Pediatrics Physician
  • Bloomington, IN
National Provider Identifier
1750320545
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01080306A Issued in IN
Practice address
350 S Landmark Ave
Bloomington, IN 47403-5001
Phone
(812) 335-2434
Fax
(812) 335-7604
NPI assigned
Jun 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 37379 SC
Pediatrics Physician 208000000X 01080306A IN Primary

Addresses

Primary practice location

350 S Landmark Ave
Bloomington, IN 47403-5001

Mailing address

250 N Shadeland Ave
Indianapolis, IN 46219-4959

Other practice location 1

171 Ashley Ave
Charleston, SC 29425-8908
Phone (843) 792-1414

Other identifiers 1

IdentifierTypeStateIssuer
8452278MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address NCHAO@direct.iuhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, NC2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20211025000499 IN Practitioner - Pediatric Medicine 5395771133 Reassigns benefits to 1 organization
I20221213000553 NC Practitioner - Pediatric Medicine 5395771133 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37379SCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana University Health Southern Indiana Physicians, LLC CurrentSince Dec 5, 2021 Accepting new patients
Carolinas Medical Center Pediatrics CurrentSince Nov 22, 2023 Accepting new patients
Carolinas Medical Center CurrentSince Nov 22, 2023 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jan 14, 2023 Accepting new patients
Carolinas Physicians Network Inc Pediatrics CurrentSince Jan 14, 2023 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Pediatrics CurrentSince Dec 19, 2022 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Dec 19, 2022 Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
Carolinas Medical Center Pediatrics Current Accepting new patients
Indiana University Health Southern Indiana Physicians LLC CurrentSince Dec 5, 2021 Accepting new patients
Charlotte Pediatric Clinic Pediatrics Current Accepting new patients
Carolinas Physicians Network Inc PastSince Dec 19, 2022 Accepting new patients

Locations

727 W 2nd St
Bloomington, IN 47403
Phone (812) 353-3450

350 S Landmark Ave
Bloomington, IN 47403
Phone (812) 332-9874

250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174

1350 S Kings Dr
Charlotte, NC 28207
Phone (704) 446-1255

13640 Steelecroft Pkwy
Ste 210
Charlotte, NC 28278
Phone (704) 512-6100

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

200 Medical Park Dr
Ste 250
Concord, NC 28025
Phone (704) 403-2740

3173 W Highway 74
Monroe, NC 28110
Phone (704) 283-2000

Interoperability endpoints

  • Direct secure messaging: nchao1085679@carolinashealthcaresystem.direct-ci.com
  • Direct secure messaging: nchao@direct.iuhealth.org

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1750320545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035001",
            "telephone_number": "812-335-2434",
            "fax_number": "812-335-7604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "171 Ashley Ave",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294258908",
            "country_code": "US",
            "telephone_number": "843-792-1414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAO",
        "first_name": "NICOLE",
        "middle_name": "TIEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-06",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "37379",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01080306A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8452278",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "NCHAO@direct.iuhealth.org",
            "affiliation": "N",
            "address_1": "350 S Landmark Ave",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474035001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.