NPIMap

Individual provider Active NPI

Jennifer Olivia Chan, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Walnut Creek, CA
National Provider Identifier
1265634687
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
A87218 Issued in CA
Practice address
2637 Shadelands Dr
Walnut Creek, CA 94598-2512
Phone
(925) 932-6330
Fax
(925) 932-0139
NPI assigned
Jun 5, 2007
Last updated
Nov 13, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A87218 CA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X A87218 CA Primary

Addresses

Primary practice location

2637 Shadelands Dr
Walnut Creek, CA 94598-2512

Mailing address

2637 Shadelands Dr
Walnut Creek, CA 94598-2512
Phone (925) 932-6330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100907000633 CA Practitioner - Thoracic SurgeryPractitioner - General Surgery 6406970805 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Thoracic SurgeryAlso: General Surgery
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Bass Medical GroupGroup PAC ID 9032111281, 292 clinicians

Practice addresses (Care Compare)

1505 Saint Alphonsus Way
Alamo, CA 94507-1570
Phone (925) 932-6330

2637 Shadelands Dr
Walnut Creek, CA 94598-2512
Phone (925) 378-4512

365 Lennon LN
Walnut Creek, CA 94598-5915

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A87218CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John Muir Trauma Physicians Billing Service Current Accepting new patients
Bass Medical Group CurrentSince Apr 10, 2022 Accepting new patients
Bass Medical Group Current Accepting new patients
Washington Township Medical Foundation Surgery CurrentSince Oct 22, 2018 Accepting new patients
Bass Medical Group CurrentSince Apr 10, 2022 Accepting new patients
Washington Township Medical Foundation CurrentSince Oct 22, 2018 Accepting new patients
John Muir Trauma Physicians Billing Service CurrentSince Sep 19, 2022 Accepting new patients
Washington Township Hospital District Past Accepting new patients
Washington Hospital Center Corp Surgery Past Accepting new patients
John Muir Health Past Accepting new patients
Eden Medical Center/San Leandro Hospital Campus Past Accepting new patients
San Ramon Regional Medical Center, LLC Past Accepting new patients

Locations

1505 Saint Alphonsus Way
Alamo, CA 94507
Phone (925) 837-4225

2500 Mowry Ave
Ste 255
Fremont, CA 94538

39141 Civic Center Dr
Ste 335
Fremont, CA 94538
Phone (510) 248-1400

39500 Fremont Blvd
Ste 100
Fremont, CA 94538
Phone (510) 248-1800

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598
Phone (925) 295-1545

2637 Shadelands Dr
Walnut Creek, CA 94598
Phone (925) 627-3424

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jchan152044@ehr.johnmuirhealth.com
  • Direct secure messaging: jchan443751@hisp.ehr.sutterhealth.org

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731456000000",
    "number": "1265634687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2637 SHADELANDS DR",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982512",
            "telephone_number": "925-932-6330",
            "fax_number": "925-932-0139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2637 SHADELANDS DR",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945982512",
            "telephone_number": "925-932-6330",
            "fax_number": "925-932-0139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JENNIFER",
        "middle_name": "OLIVIA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-05",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A87218",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "A87218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

Verify at the official NPI Registry.