Active NPI
Su-Pen Bobby Chang, MD
- Anesthesiology Physician
- Boston, MA
National Provider Identifier
1851344741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 76235
- Practice address
- 1 Boston Medical Ctr PL
Boston, MA 02118-2908 - Phone
- (617) 638-6950
- NPI assigned
- May 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Anesthesiology) Physician | 207LC0200X | 76235 | MA | |
| Anesthesiology Physician | 207L00000X | 76235 | MA | Primary |
Addresses
Primary practice location
1 Boston Medical Ctr PL
Boston, MA 02118-2908
Mailing address
801 Albany St
FL G
Boston, MA 02119
Phone (617) 414-5405
Other practice location 1
164 Summit Ave
Providence, RI 02906-2853
Phone (401) 793-4574
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110051609B | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 76235 | MA | MD | Critical Care Medicine (Anesthesiology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601942400000",
"number": "1851344741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 ALBANY ST",
"address_2": "FL G",
"city": "BOSTON",
"state": "MA",
"postal_code": "02119",
"telephone_number": "617-414-5405",
"fax_number": "617-414-6031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BOSTON MEDICAL CTR PL",
"city": "BOSTON",
"state": "MA",
"postal_code": "021182908",
"telephone_number": "617-638-6950"
}
],
"practiceLocations": [
{
"address_1": "164 Summit Ave",
"address_purpose": "LOCATION",
"city": "Providence",
"state": "RI",
"postal_code": "029062853",
"country_code": "US",
"telephone_number": "401-793-4574",
"fax_number": "401-454-1321",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CHANG",
"first_name": "SU-PEN BOBBY",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-19",
"last_updated": "2020-10-06",
"certification_date": "2020-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "207LC0200X",
"taxonomy_group": "",
"desc": "Anesthesiology, Critical Care Medicine",
"state": "MA",
"license": "76235",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "MA",
"license": "76235",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110051609B",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.