NPIMap

Individual provider Active NPI

Sidney Boyd Chadwell Jr., D.O.

  • Family Medicine Physician
  • Palestine, TX
National Provider Identifier
1902827801
Registry record updated May 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G4452 Issued in TX
Practice address
4201 S Loop 256
Palestine, TX 75801-8476
Phone
(903) 723-8533
Fax
(903) 723-5190
NPI assigned
Jul 23, 2006
Last updated
May 29, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G4452 TX Primary

Addresses

Primary practice location

4201 S Loop 256
Palestine, TX 75801-8476

Mailing address

4201 S Loop 256
Palestine, TX 75801-8476
Phone (903) 723-8533

Other identifiers 1

IdentifierTypeStateIssuer
130873602MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20100520000930 TX Practitioner - Family PracticePractitioner - Geriatric Medicine 8729031612 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Texas Family Medicine PAGroup PAC ID 9436120086, 5 clinicians

Practice addresses (Care Compare)

4201 S Loop
Suite 256
Palestine, TX 75801-8476
Phone (903) 723-8533

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
East Texas Family Medicine PA Family Medicine CurrentSince Apr 30, 2012 Accepting new patients
Williams Healtcare,Inc. PastSince Jan 31, 2007 Accepting new patients
Liberty County Hospital District No. 1 Past Accepting new patients

Locations

4201 S Loop 256
Palestine, TX 75801
Phone (903) 723-8533

Interoperability endpoints

  • Direct secure messaging: kze4550@yourcarecommunity.org

Organizations & group practices 3

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 9

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": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338249600000",
    "number": "1902827801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 S LOOP 256",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758018476",
            "telephone_number": "903-723-8533",
            "fax_number": "903-723-5190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 S LOOP 256",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758018476",
            "telephone_number": "903-723-8533",
            "fax_number": "903-723-5190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHADWELL",
        "first_name": "SIDNEY",
        "middle_name": "BOYD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-23",
        "last_updated": "2012-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "G4452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130873602",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palestine, TX

Sources for this page

Verify at the official NPI Registry.