Active NPI
Jeffrey Chao, MD
- Emergency Medicine Physician
- Ann Arbor, MI
National Provider Identifier
1922201698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- A115739
- 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
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 |
|---|---|---|---|---|
| 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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| 115739 | CA | MD | Clinical Social Worker |
| A115739 | CA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Southern California Permanente Medical Group | Current | 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.
-
- Health Maintenance Organization
- Riverside, CA
- NPI 1316979834
CA
-
- Health Maintenance Organization
- Santa Clarita, CA
- NPI 1316409410
-
- Health Maintenance Organization
- Fontana, CA
- NPI 1689606196
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.