Individual provider Active NPI

Jeffrey Chao, MD

  • Emergency Medicine Physician
  • Ann Arbor, MI
National Provider Identifier
1922201698
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A115739 Issued in CA
Practice address
1500 E Medical Center Dr
B1-380 TC, SPC 5305
Ann Arbor, MI 48109-5000
Phone
(734) 763-7919
Fax
(734) 763-9298
NPI assigned
Jun 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A115739 CA Primary

Addresses

Primary practice location

1500 E Medical Center Dr
B1-380 TC, SPC 5305
Ann Arbor, MI 48109-5000

Mailing address

303 S Main St
Suite 302
Ann Arbor, MI 48104-2180
Phone (630) 670-8762

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20111005000658 CA Practitioner - Emergency Medicine 4082886502 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
115739CAMDClinical Social Worker
A115739CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Aug 20, 2011 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 20, 2011 Accepting new patients

Locations

9961 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3910

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1922201698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 S MAIN ST",
            "address_2": "SUITE 302",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481042180",
            "telephone_number": "630-670-8762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR",
            "address_2": "B1-380 TC, SPC 5305",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095000",
            "telephone_number": "734-763-7919",
            "fax_number": "734-763-9298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAO",
        "first_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-08",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A115739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9961 Sierra Ave",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.