NPIMap

Individual provider Active NPI

Jack Jienan Fang, M.D.

  • Hospitalist Physician
  • Rego Park, NY
National Provider Identifier
1083904080
Registry record updated Mar 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
260808 Issued in MA
Practice address
6265 Saunders St Apt 5G
Rego Park, NY 11374-1576
Phone
(347) 205-7909
NPI assigned
Apr 11, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2018

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 260808 MA
Hospitalist Physician 208M00000X 260808 MA Primary

Addresses

Primary practice location

6265 Saunders St Apt 5G
Rego Park, NY 11374-1576

Mailing address

4323 Colden St Apt 19M
Flushing, NY 11355-5926
Phone (347) 205-7909

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141121000477 MA Practitioner - HospitalistPractitioner - Internal Medicine 6608098967 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lahey Clinic IncGroup PAC ID 2264336528, shared by 3 NPIs, 1,381 clinicians
Lowell General Inpatient Specialists PLLCGroup PAC ID 8729371380, 70 clinicians
Winchester Lahey Inpatient Specialists PLLCGroup PAC ID 6608150149, 30 clinicians

Practice addresses (Care Compare)

29 Mall Rd
Burlington, MA 01805-0001

295 Varnum Ave
Lowell, MA 01854-2134
Phone (978) 937-6439

41 Highland Ave
Winchester, MA 01890-1446
Phone (781) 729-9000

41 Mall Rd
Burlington, MA 01805-0001

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.98 of 100Reported as apm
Quality
76.59
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lahey Clinic, Inc Internal Medicine CurrentSince Sep 16, 2014 Accepting new patients
Lowell General Inpatient Specialists PLLC Internal Medicine CurrentSince Dec 5, 2024 Accepting new patients
Lahey Clinic, Inc. Internal Medicine CurrentSince Sep 15, 2014 Accepting new patients
Beth Israel Lahey Health Primary Care Inc CurrentSince Sep 21, 2025 Accepting new patients
Winchester Lahey Inpatient Specialists PLLC Internal Medicine CurrentSince Feb 1, 2025 Accepting new patients
Beth Israel Lahey Health Primary Care, Inc. CurrentSince Sep 21, 2025 Accepting new patients
The Lowell General Hospital Past Accepting new patients
Lahey Clinic Hospital, Inc. Past Accepting new patients

Locations

85 Herrick St
Beverly, MA 01915
Phone (978) 816-3700

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400

295 Varnum Ave
Lowell, MA 01854
Phone (978) 788-7344

15 Railroad Ave
South Hamilton, MA 01982
Phone (978) 468-7381

41 Highland Ave
Winchester, MA 01890
Phone (781) 756-2000

1 Harbison Way
Ste 222
Columbia, SC 29212

Interoperability endpoints

  • FHIR API: https://fhir.laheyhealth.org/proxy-prd-fhir/api/FHIR/R4/
  • Direct secure messaging: jfang14108@direct.bilh.masshiway.net
  • Direct secure messaging: jfang134727@tuftsmedicine.direct-ci.com
  • FHIR API: https://api.platform.athenahealth.com/10729/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-myrecord.cerner.com/r4/d04f75c7-2a62-4686-b520-7bf0635f38f0/

Organizations & group practices 8

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 5

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": "1302480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522022400000",
    "number": "1083904080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4323 COLDEN ST APT 19M",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555926",
            "telephone_number": "347-205-7909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6265 SAUNDERS ST APT 5G",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113741576",
            "telephone_number": "347-205-7909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANG",
        "first_name": "JACK",
        "middle_name": "JIENAN",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-11",
        "last_updated": "2018-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "260808",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MA",
            "license": "260808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rego Park, NY

Sources for this page

Verify at the official NPI Registry.