Individual provider Active NPI

Wan Tan Chang, M.D.

  • Family Medicine Physician
  • Flushing, NY
National Provider Identifier
1174866859
Registry record updated Mar 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
285418 Issued in NY
Practice address
3808 Union St Ste 3K
Flushing, NY 11354-5670
Phone
(718) 886-3681
NPI assigned
Apr 1, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036140874 IL
Family Medicine Physician 207Q00000X 285418 NY Primary

Addresses

Primary practice location

3808 Union St Ste 3K
Flushing, NY 11354-5670

Mailing address

3808 Union St Ste 3K
Flushing, NY 11354-5670
Phone (718) 578-1318

Other practice location 1

1701 Curtis Rd
Convenient Care
Champaign, IL 61822-9678
Phone (217) 365-6203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20161103002235 IL Practitioner - Family Practice 5395047641 Reassigns benefits to 2 organizations
I20200331003177 NY Practitioner - Family Practice 5395047641 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

3726 Junction Blvd
Corona, NY 11368-1741
Phone (718) 571-9310

3808 Union St
Suite 3K
Flushing, NY 11354-5670
Phone (718) 578-1318

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036140874ILMDFamily Medicine Physician
285418NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
City Medical of Upper East Side, PLLC CurrentSince May 1, 2021 Accepting new patients
City Medical of Upper East Side, PLLC CurrentSince May 1, 2021 Accepting new patients
Hoopeston Community Memorial Hospital Family Medicine Current Accepting new patients
Hoopeston Community Memorial Hospital Current Accepting new patients
Centerhealth Medical PLLC Family Medicine CurrentSince Dec 28, 2019 Accepting new patients
City Medical of Upper East Side, PLLC Current Accepting new patients
Hoopeston Community Memorial Hospital CurrentSince Jan 21, 2018 Accepting new patients
Carle Health Care Incorporated Family Medicine CurrentSince Oct 18, 2016 Accepting new patients

Locations

1701 Curtis Rd
Champaign, IL 61822
Phone (217) 365-6201

701 E Orange St
Hoopeston, IL 60942
Phone (217) 283-5531

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

2248 31st St
Astoria, NY 11105
Phone (718) 267-1333

3111 Steinway St
Astoria, NY 11103
Phone (718) 475-2345

3726 Junction Blvd
Flushing, NY 11368
Phone (718) 571-9310

3808 Union St
Ste 3K
Flushing, NY 11354
Phone (718) 578-1318

336 E 86th St
New York, NY 10028
Phone (212) 772-3627

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Interoperability endpoints

  • Direct secure messaging: wan-tan.chang.1@2983.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1174866859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3808 UNION ST STE 3K",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545670",
            "telephone_number": "718-578-1318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3808 UNION ST STE 3K",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545670",
            "telephone_number": "718-886-3681"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1701 Curtis Rd",
            "address_2": "Convenient Care",
            "address_purpose": "LOCATION",
            "city": "Champaign",
            "state": "IL",
            "postal_code": "618229678",
            "country_code": "US",
            "telephone_number": "217-365-6203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHANG",
        "first_name": "WAN TAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-01",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036140874",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "285418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.