Dan Chaksupa, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

2005-01602 Issued in NC

Practice address

3521 Haworth Dr
Raleigh, NC 27609-7244

Phone

(919) 782-1669

Fax

(919) 782-4756

NPI assigned

Aug 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Specialty

Internal Medicine

Education

West Virginia University School of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Raleigh Medical Group PAGroup PAC ID 6800874322, 99 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rex Hospital Hospital, Raleigh, NC, CCN 340114

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: danchaksupa@rcmg.allscriptsdirect.net

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.

• Raleigh Medical Group, PA

  • Internal Medicine Physician
  • Raleigh, NC
  • NPI 1104962315
  Medicare reassignment Care Compare group NPD
• Raleigh Adult Medicine PA

  • Internal Medicine Physician
  • Raleigh, NC
  • NPI 1902840762
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Rex Hospital Inc.

  • General Acute Care Hospital
  • Raleigh, NC
  • NPI 1497797088
  Care Compare affiliation

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299542400000",
    "number": "1992819676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18563",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276198563",
            "telephone_number": "919-782-1806",
            "fax_number": "919-782-1669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3521 HAWORTH DR",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276097244",
            "telephone_number": "919-782-1669",
            "fax_number": "919-782-4756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAKSUPA",
        "first_name": "DAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2011-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2005-01602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902990",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Rhiannon Chadwick, NP
• Molly Chaffee
• Claire Chai
• Chain Effect
• Chain Effect Physical Therapy and Performance Enhancement
• Julianna Renee Chalk
• Challenging Choices LLC
• Eric D Challgren, M.D.
• Sara Ann Chamberlain, CRNA
• Acoeya Chambers

• Internal Medicine Physician in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.