NPIMap

Individual provider Active NPI

Stefan Nathan Chock, MD

  • Surgery Physician
  • Las Vegas, NV
National Provider Identifier
1811966062
Registry record updated Apr 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
11562 Issued in NV
Practice address
3131 La Canada St Ste 217
Las Vegas, NV 89169-2579
Phone
(702) 369-7152
Fax
(702) 369-7153
NPI assigned
Mar 17, 2006
Last updated
Apr 10, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 11562 NV Primary
Surgical Critical Care Physician 2086S0102X 11562 NV

Addresses

Primary practice location

3131 La Canada St Ste 217
Las Vegas, NV 89169-2579

Mailing address

3131 La Canada St Ste 217
Las Vegas, NV 89169-2579
Phone (702) 369-7152

Other identifiers 3

IdentifierTypeStateIssuer
XPY205017MedicaidCA
975089MedicaidAZ
100507449MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051130000323 NV Practitioner - General SurgeryPractitioner - Other (Physician) 0941220313 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Maryland School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Desert Surgical Associates Fisher PLLCGroup PAC ID 3375671803, 7 clinicians

Practice addresses (Care Compare)

3131 La Canada St
Suite 217
Las Vegas, NV 89169-2579
Phone (702) 369-7152

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Desert Surgical Associates Fisher PLLC Surgery CurrentSince Mar 1, 2010 Accepting new patients
Desert Springs Hospital Past Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
Sunrise Trauma Services LLC Surgery Past Accepting new patients

Locations

3131 La Canada St
Ste 217
Las Vegas, NV 89169
Phone (702) 369-7152

3186 S Maryland Pkwy
Las Vegas, NV 89109
Phone (702) 731-8000

3196 S Maryland Pkwy
Ste 101
Las Vegas, NV 89109
Phone (702) 731-8099

3196 S Maryland Pkwy
Ste 101A
Las Vegas, NV 89109
Phone (702) 369-7152

Organizations & group practices 5

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 5

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": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586476800000",
    "number": "1811966062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 LA CANADA ST STE 217",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891692579",
            "telephone_number": "702-369-7152",
            "fax_number": "702-369-7153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 LA CANADA ST STE 217",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891692579",
            "telephone_number": "702-369-7152",
            "fax_number": "702-369-7153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHOCK",
        "first_name": "STEFAN",
        "middle_name": "NATHAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2020-04-10",
        "certification_date": "2020-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NV",
            "license": "11562",
            "primary": true
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "NV",
            "license": "11562",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XPY205017",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "975089",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100507449",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.