SOTHEARY CHAN, PA — NPI 1750551818 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical in FAIRFAX, SC)

CMS-1500 Box 24J / 33a • NPI

1750551818

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363AM0700X (CMS 97)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical

Box 32 Service Location & ZIP+4

1787 ALLENDALE FAIRFAX HWY, FAIRFAX, SC, 29827-9133

✓ 9-Digit EDI 837 ZIP+4 (29827-9133)

Practice Phone & Referral Fax

(803) 632-1176

Fax: (803) 632-2410

⚠️ HHS OIG LEIE FEDERAL EXCLUSION ALERT: NPI 1750551818 matches an active entry in the HHS Office of Inspector General List of Excluded Individuals/Entities (Social Security Act 1128b1 — Effective 2011-12-20). Verify before submitting Medicare/Medicaid claims.

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1750551818` (NPI-1 Individual Practitioner)
Provider / Legal Name	SOTHEARY CHAN, PA
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical NUCC Code: `363AM0700X` (Physician Assistant, Medical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1787 ALLENDALE FAIRFAX HWY, FAIRFAX, SC, 29827-9133
Practice Telephone / Fax	Tel: (803) 632-1176 \| Fax: (803) 632-2410
Administrative Mailing Address	PO BOX 218, FAIRFAX, SC, 29827-0218
Enumeration & Last Sync	Enumerated: 2008-03-05 \| CMS Record Updated: 2008-03-05

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1787 ALLENDALE FAIRFAX HWY, FAIRFAX, SC, 29827-9133

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Plain-English Taxonomy & CMS Crosswalk (363AM0700X)

What Does Taxonomy Code 363AM0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363AM0700X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 97 (Physician Assistant)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physician Assistant, Medical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (SOTHEARY CHAN, PA)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363AM0700X` — Physician Assistant, Medical Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical	State: SC \| License: `1272` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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SOTHEARY CHAN, PA (NPI #1750551818)