John Chan, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME 123976 Issued in FL

Practice address

2140 Smith St
Orange Park, FL 32073-5554

Phone

(904) 269-2140

Fax

(904) 264-3018

NPI assigned

Jun 18, 2008

Last updated

Dec 24, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jchan28502@baptisthealthsystemjacksonville.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Baptist Primary Care Inc

  • Pediatrics Physician
  • Fleming Island, FL
  • NPI 1457791246
  NPD (past)
• Baptist Primary Care Inc

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1508817529

  Pediatrics

  NPD (past)
• Baptist Primary Care, Inc.

  • Pediatrics Physician
  • Jacksonville, FL
  • NPI 1861634818
  NPD (past)

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

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545609600000",
    "number": "1013178433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45443",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841450443",
            "telephone_number": "904-202-1032",
            "fax_number": "904-376-4107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2140 SMITH ST",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735554",
            "telephone_number": "904-269-2140",
            "fax_number": "904-264-3018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-18",
        "last_updated": "2018-12-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101246006",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME 123976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016263600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Cecere, DPM
• Centerwell Health Services (Certified), Inc. (Centerwell Home Health)
• Certified Medical Systems I, Inc
• Minor Chamblin, PH.D
• Allison Culbreth Chan, MD
• Sushama Channaveeraiah
• Ashlee Kyler Channell
• Cassandra Grace Chappell
• Charis Home Care Services LLC
• Charles H. Hudgins

• Pediatrics Physician in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.