Jerry Lynn Chastain Jr., M.D.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

401 Paradise Road
Suite E
Modesto, CA 95351

Phone

(209) 558-4000

NPI assigned

Feb 5, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

Family Practice

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bristol Hospice Fresno Hospice, Fresno, CA, CCN 051769
• Kaiser Foundation Hospital - Fresno Hospital, Fresno, CA, CCN 050710

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment Care Compare group NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD

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

• Kaiser Foundation Hospitals

  • General Acute Care Hospital
  • Fresno, CA
  • NPI 1083784672
  Care Compare affiliation
• Optimal Hospice, Inc.

  • Community Based Hospice Care Agency
  • Fresno, CA
  • NPI 1164590089
  Care Compare affiliation

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

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642982400000",
    "number": "1073752671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 PARADISE ROAD",
            "address_2": "SUITE E",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "95351",
            "telephone_number": "209-558-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 PARADISE ROAD",
            "address_2": "SUITE E",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "95351",
            "telephone_number": "209-558-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHASTAIN",
        "first_name": "JERRY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-05",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "40595 Westlake Dr",
            "city": "Oakhurst",
            "state": "CA",
            "country_code": "US",
            "postal_code": "936449024",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Charles Slocumb M.D.
• Julie Ann Charles, PHARMD
• Ivy Charlton
• Scott Michael Charlton
• Rebekah Elizabeth Chase, MSN, FNP-C
• Richard Chau, D.C.
• Yan Chau
• Prakashchandra Jivrambhai Chaudhari, MD
• Leena Chaudhury, M.D.
• Tuhin Chaudhury, M.D.

• Student in an Organized Health Care Education/Training Program in Modesto, CA
• Providers in Modesto, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.