Individual provider Active NPI

Jenny Jia, MD

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1043605926
Registry record updated Sep 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036157407 Issued in IL
Practice address
675 N Saint Clair St Ste 18-200
Chicago, IL 60611-5929
Phone
(312) 695-8630
Fax
(312) 695-2857
NPI assigned
Mar 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 272882 MA
Internal Medicine Physician 207R00000X 036157407 IL Primary

Addresses

Primary practice location

675 N Saint Clair St Ste 18-200
Chicago, IL 60611-5929

Mailing address

675 N Saint Clair St Ste 18-200
Chicago, IL 60611-5929
Phone (312) 695-8630

Other practice location 1

15 Parkman St
Boston, MA 02114
Phone (617) 726-2707

Other practice location 2

15 Parkman St
Boston, MA 02114
Phone (617) 726-2707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190517001395 MA Practitioner - Internal Medicine 1557676491 Reassigns benefits to 2 organizations
I20210823001417 IL Practitioner - Internal Medicine 1557676491 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

675 N St Clair
200 Dept of Internal Med
Chicago, IL 60611-5975
Phone (312) 695-8630

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts General Physicians Organization Inc Internal Medicine CurrentSince Jul 1, 2019 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2021 Accepting new patients
The General Hospital Corporation CurrentSince Jul 1, 2019 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Sep 1, 2021 Accepting new patients
Central Dupage Physician Group Internal Medicine Past Accepting new patients

Locations

Dept 5777
Carol Stream, IL 60122

675 N Saint Clair St
Ste 18-200
Chicago, IL 60611
Phone (312) 695-4525

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

55 Fruit St
Boston, MA 02114

55 Fruit St
#2
Boston, MA 02114
Phone (617) 726-2967

15 Parkman St
Boston, MA 02114
Phone (617) 726-3023

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1043605926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 18-200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115929",
            "telephone_number": "312-695-8630",
            "fax_number": "312-695-2857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 N SAINT CLAIR ST STE 18-200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606115929",
            "telephone_number": "312-695-8630",
            "fax_number": "312-695-2857"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15 Parkman St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02114",
            "country_code": "US",
            "telephone_number": "617-726-2707",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15 Parkman St",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02114",
            "country_code": "US",
            "telephone_number": "617-726-2707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JIA",
        "first_name": "JENNY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-30",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "272882",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036157407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.