Active NPI
Chase Montgomery Maddox
- Peer Specialist
- Brooklyn, NY
National Provider Identifier
1902667629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- NYCPS-P-200062
- Practice address
- 1623 Flatbush Ave Ste 4
Brooklyn, NY 11210-3264 - Phone
- (718) 377-5755
- NPI assigned
- Jan 19, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | NYCPS-P-200062 | NY | Primary |
Addresses
Primary practice location
1623 Flatbush Ave Ste 4
Brooklyn, NY 11210-3264
Mailing address
517 W 161St St Apt 65
New York, NY 10032-6115
Phone (347) 894-7025
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NYCPS-P-200062 | NY | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705622400000",
"number": "1902667629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "517 W 161ST ST APT 65",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100326115",
"telephone_number": "347-894-7025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1623 FLATBUSH AVE STE 4",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112103264",
"telephone_number": "718-377-5755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDOX",
"first_name": "CHASE",
"middle_name": "MONTGOMERY",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-01-19",
"last_updated": "2024-01-19",
"certification_date": "2024-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NY",
"license": "NYCPS-P-200062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.