Basic Information
Provider Information | |||||||||
NPI: | 1730172883 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHAMBERLIN | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1500 SW 10TH AVE | ||||||||
Address2: |   | ||||||||
City: | TOPEKA | ||||||||
State: | KS | ||||||||
PostalCode: | 666041301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7853545242 | ||||||||
FaxNumber: | 7853546349 | ||||||||
Practice Location | |||||||||
Address1: | 1500 SW 10TH AVE | ||||||||
Address2: |   | ||||||||
City: | TOPEKA | ||||||||
State: | KS | ||||||||
PostalCode: | 666041301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7853545242 | ||||||||
FaxNumber: | 7853546349 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/24/2005 | ||||||||
LastUpdateDate: | 02/15/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/15/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | R2E61 | MO | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 21527 | KS | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 12531038 | 01 |   | BCBS | OTHER | 202253415 | 05 | MO |   | MEDICAID | 2292233 | 01 |   | AETNA | OTHER | 100349200C | 05 | KS |   | MEDICAID | 068002006 | 01 | KS | MEDICARE PTAN | OTHER | 330230 | 01 |   | FIRST GUARD | OTHER |