Individual provider Active NPI

Jian Li

  • Family Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1114397387
Registry record updated Feb 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP015091 Issued in PA
Practice address
4050 S 26TH St
Jefferson Comprehensive Concussion Center
Philadelphia, PA 19112-1613
Phone
(267) 463-2284
NPI assigned
Oct 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP015091 PA Primary

Addresses

Primary practice location

4050 S 26TH St
Jefferson Comprehensive Concussion Center
Philadelphia, PA 19112-1613

Mailing address

4050 S 26TH St
Jefferson Comprehensive Concussion Center
Philadelphia, PA 19112-1613

Other identifiers 1

IdentifierTypeStateIssuer
103072759MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20160114000893 PA Practitioner - Nurse Practitioner 5698078293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians

Practice addresses (Care Compare)

4050 S 26TH St
Philadelphia, PA 19112-1613
Phone (267) 463-2284

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP015091PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians CurrentSince Nov 22, 2015 Accepting new patients
Jefferson University Physicians Past Accepting new patients

Locations

3 Crescent Dr
Fl 3
Philadelphia, PA 19112
Phone (215) 503-3321

4050 S 26th St
Philadelphia, PA 19112
Phone (267) 463-2284

909 Walnut St
#2
Philadelphia, PA 19107
Phone (215) 955-7000

1101 Chestnut St
Fl 10
Philadelphia, PA 19107
Phone (215) 587-3000

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 2

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": "1443657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454889600000",
    "number": "1114397387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4050 S 26TH ST",
            "address_2": "JEFFERSON COMPREHENSIVE CONCUSSION CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191121613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 S 26TH ST",
            "address_2": "JEFFERSON COMPREHENSIVE CONCUSSION CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191121613",
            "telephone_number": "267-463-2284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LI",
        "first_name": "JIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-01",
        "last_updated": "2016-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP015091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103072759",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.