MEDICARE: DR. RONALD G CHAMBERS I M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G27170	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	ZZZ01370Z	OTHER	CA	MEDICARE PTAN
9	ZZZ01370Z	OTHER		MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D0714372	OTHER	CA	CLIA NUMBER
2	21565	OTHER	CA	WEB MD ACCT NUMBER
3	BLUE CROSS	OTHER	CA	00G271700
4	4490118	OTHER	CA	MEDI-CAL PIN NUMBER
5	1243370356	OTHER	CA	VITERA ACCOUNT
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	BLUE SHIELD	OTHER	CA	00G271700
10	00G271700	OTHER	CA	BLUE SHIELD ID NUMBER
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	013204	OTHER	CA	AMER BD OF FAMILY PRACTIC
13	G27170	OTHER	CA	CALIF STATE LICENSE NUMBE

General Provider Information

NPI Number	:	1215920319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD G CHAMBERS I M.D.

Provider Business Mailing Address
First Line	:	4174 ASHBY CT
Second Line	:
City	:	SHASTA LAKE
State	:	CA
Zip	:	96019-9215
Country	:	US
Telephone Number	:	530-275-3094
Fax Number	:	530-275-0803

Provider Business Practice Location Address
First Line	:	4174 ASHBY CT
Second Line	:
City	:	SHASTA LAKE
State	:	CA
Zip	:	96019-9215
Country	:	US
Telephone Number	:	530-275-3094
Fax Number	:	530-275-0803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	03/07/2023

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