Individual provider Active NPI

Ronald G Jan, MD

  • Vascular Surgery Physician
  • Sacramento, CA
National Provider Identifier
1114018199
Registry record updated Feb 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
G22975 Issued in CA
Practice address
5025 J St
Suite 312
Sacramento, CA 95819
Phone
(916) 288-0055
Fax
(916) 288-0056
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X G229750 CA
Vascular Surgery Physician 2086S0129X G22975 CA Primary

Addresses

Primary practice location

5025 J St
Suite 312
Sacramento, CA 95819

Mailing address

5025 J St
Suite 312
Sacramento, CA 95819
Phone (916) 288-0055

Other identifiers 1

IdentifierTypeStateIssuer
00G229750MedicaidCA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20051019000538 CA Practitioner - Vascular SurgeryPractitioner - Internal Medicine 5395761399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: Internal Medicine
Education
George Washington University School of Medicine, 1971
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5025 J St
Suite 312
Sacramento, CA 95819-3839
Phone (916) 288-0055

Hospital & facility affiliations

  • Mercy General Hospital Hospital, Sacramento, CA, CCN 050017

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)28

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G229750CAMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ronald G. Jan, M.D., Inc Vascular Surgery Current Accepting new patients
Ronald G. Jan, M.D. Inc CurrentSince Jun 16, 2018 Accepting new patients
Sutter North Medical Foundation Past Accepting new patients

Locations

4001 J St
Sacramento, CA 95819
Phone (916) 453-4037

5025 J St
Ste 312
Sacramento, CA 95819
Phone (916) 288-0055

Organizations & group practices 3

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": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362009600000",
    "number": "1114018199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5025 J ST",
            "address_2": "SUITE 312",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95819",
            "telephone_number": "916-288-0055",
            "fax_number": "916-288-0056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5025 J ST",
            "address_2": "SUITE 312",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95819",
            "telephone_number": "916-288-0055",
            "fax_number": "916-288-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAN",
        "first_name": "RONALD",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2013-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "G229750",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "G22975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G229750",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.