Jackie Phan, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

A109180 Issued in CA

Practice address

1900 Sullivan Ave
Daly City, CA 94015-2200

Phone

(650) 991-6816

NPI assigned

Feb 5, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Anesthesiology

Education

University of California, San Diego School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

G2 Anesthesia PCGroup PAC ID 3375873599, 104 clinicians

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Premier Anesthesia of California PCGroup PAC ID 5092897025, 44 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Stanford Health Care Tri-Valley Hospital, Pleasanton, CA, CCN 050283

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations (25 of 30)

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.

• G2 Anesthesia PC

  • Anesthesiology Physician
  • Los Gatos, CA
  • NPI 1487214698
  Medicare reassignment Care Compare group NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  Anesthesiology

  Medicare reassignment Care Compare group NPD
• Premier Anesthesia of California, PC

  • Anesthesiology Physician
  • San Ramon, CA
  • NPI 1770691859
  Medicare reassignment Care Compare group NPD
• Cep America - Anesthesia, PC

  • Anesthesiology Physician
  • Walnut Creek, CA
  • NPI 1790401438
  Medicare reassignment NPD
• John Muir Trauma Physicians Billing Service

  • Hospitalist Physician
  • Walnut Creek, CA
  • NPI 1093864837
  Medicare reassignment NPD
• Cep America - Anesthesia PC

  dba Vituity

  • Anesthesiology Physician
  • San Jose, CA
  • NPI 1598214108
  NPD
• John Muir Trauma Physicians Billing Service

  • Trauma Surgery Physician
  • Walnut Creek, CA
  • NPI 1962551861

  Anesthesiology

  NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Richmond, CA
  • NPI 1235226531

  Anesthesiology

  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Cep America - Anesthesia PC

  • Anesthesiology Physician
  • Langhorne, PA
  • NPI 1093678229
  NPD
• Cep America - Anesthesia PC

  • Anesthesiology Physician
  • Fremont, CA
  • NPI 1982009759
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Stanford Health Care Tri-Valley

  • General Acute Care Hospital
  • Pleasanton, CA
  • NPI 1144389941
  Care Compare affiliation

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

{
    "created_epoch": "1233792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367539200000",
    "number": "1225277817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SULLIVAN AVE",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940152200",
            "telephone_number": "650-991-6816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SULLIVAN AVE",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940152200",
            "telephone_number": "650-991-6816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "JACKIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-02-05",
        "last_updated": "2013-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A109180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Farmer Dental Corp (Campus Hights Dental)
• Ognjen Petras, M.D.
• Laurie Petronis, COUNSELOR
• Nancy A. Petty, OTR CHT
• Dominic Phan-Romero
• Niam Phan, OD
• Pharmacia Inc (1800 sullivan pharmacy)
• Physicians Surgery Center
• Bethany Pianca, R.D.
• Pillars Physical Therapy Inc (Pillars Physical Therapy and Wellness Center)

• Anesthesiology Physician in Daly City, CA
• Providers in Daly City, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.