Individual provider Active NPI

Jill Chang, PA-C

  • Medical Physician Assistant
  • San Diego, CA
National Provider Identifier
1114112786
Registry record updated May 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA17949 Issued in CA
Practice address
5717 Pacific Center Blvd Ste 200
San Diego, CA 92121-4250
Phone
(858) 859-1188
NPI assigned
Sep 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA17949 CA
Surgical Physician Assistant 363AS0400X PA17949 CA
Medical Physician Assistant 363AM0700X PA17949 CA Primary

Addresses

Primary practice location

5717 Pacific Center Blvd Ste 200
San Diego, CA 92121-4250

Mailing address

5717 Pacific Center Blvd Ste 200
San Diego, CA 92121-4250
Phone (858) 859-1188

Other practice location 1

9525 Towne Centre Dr Ste 150
San Diego, CA 92121
Phone (858) 859-1188

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081009000740 CA Practitioner - Physician Assistant 0648348169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of Southern California Keck School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Monica Perlman MD IncGroup PAC ID 8820035884, 357 clinicians

Practice addresses (Care Compare)

3737 Moraga Ave
Suite B103
San Diego, CA 92117-5352
Phone (858) 799-0855

3900 5TH Ave
Suite 110
San Diego, CA 92103-3122
Phone (858) 554-1212

Hospital & facility affiliations

  • UC San Diego Health Hillcrest - Hillcrest Med Ctr Hospital, San Diego, CA, CCN 050025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA17949CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
UC San Diego Health - Rancho Family Medical Group Past Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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": "1189123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557446400000",
    "number": "1114112786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5717 PACIFIC CENTER BLVD STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921214250",
            "telephone_number": "858-859-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5717 PACIFIC CENTER BLVD STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921214250",
            "telephone_number": "858-859-1188"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9525 Towne Centre Dr Ste 150",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "92121",
            "country_code": "US",
            "telephone_number": "858-859-1188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANG",
        "first_name": "JILL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-07",
        "last_updated": "2019-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17949",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA17949",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA17949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.