NPIMap

Individual provider Active NPI

Chong So, DO

  • Family Medicine Physician
  • Dracut, MA
National Provider Identifier
1972561231
Registry record updated Mar 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
245826 Issued in MA
Practice address
1595 Bridge St
#3
Dracut, MA 01826-2696
Phone
(978) 323-2808
Fax
(978) 323-2810
NPI assigned
May 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2017

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 245826 MA Primary

Addresses

Primary practice location

1595 Bridge St
#3
Dracut, MA 01826-2696

Mailing address

1595 Bridge St
#3
Dracut, MA 01826-2696
Phone (978) 323-2808

Other identifiers 1

IdentifierTypeStateIssuer
30222401MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20110311000627 MA Practitioner - Family Practice 2567479942 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of New England, College of Osteo Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
LGH Medical Group, Inc.Group PAC ID 3173626751, 165 clinicians

Practice addresses (Care Compare)

1595 Bridge St
Suite 3
Dracut, MA 01826-2614
Phone (978) 328-8527

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
LGH Medical Group, Inc. Family Medicine CurrentSince Jun 18, 2013 Accepting new patients
LGH Professional Services LLC Past Accepting new patients
The Lowell General Hospital Past Accepting new patients
Parkland Physician Services, Inc. Family Medicine Past Accepting new patients
DO Not Use - the Lowell General Hospital Past Accepting new patients

Locations

1 Hospital Dr
Lowell, MA 01852
Phone (978) 687-0156

295 Varnum Ave
Lowell, MA 01854
Phone (978) 788-7344

Interoperability endpoints

  • Direct secure messaging: cso27267@tuftsmedicine.direct-ci.com
  • FHIR API: https://fhir-myrecord.cerner.com/r4/d04f75c7-2a62-4686-b520-7bf0635f38f0/

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490832000000",
    "number": "1972561231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1595 BRIDGE ST",
            "address_2": "#3",
            "city": "DRACUT",
            "state": "MA",
            "postal_code": "018262696",
            "telephone_number": "978-323-2808",
            "fax_number": "978-323-2810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 BRIDGE ST",
            "address_2": "#3",
            "city": "DRACUT",
            "state": "MA",
            "postal_code": "018262696",
            "telephone_number": "978-323-2808",
            "fax_number": "978-323-2810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SO",
        "first_name": "CHONG",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2017-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "245826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30222401",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dracut, MA

Sources for this page

Verify at the official NPI Registry.