Individual provider Active NPI

Lili Chan, MD

  • Nephrology Physician
  • New York, NY
National Provider Identifier
1316368061
Registry record updated Sep 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
275737 Issued in NY
Practice address
1249 5TH Avene
New York, NY 10029
Phone
(212) 360-3734
NPI assigned
Dec 25, 2013
Last updated
Sep 22, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 275737 NY Primary

Addresses

Primary practice location

1249 5TH Avene
New York, NY 10029

Mailing address

1 Gustave L Levy PL
Box 3000
New York, NY 10029-6504
Phone (212) 987-3100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20161109002945 NY Practitioner - NephrologyPractitioner - Internal Medicine 4183903446 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5 E 98TH St
New York, NY 10029-6501
Phone (212) 241-4060

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
275737NYMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Nephrology CurrentSince Oct 1, 2016 Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Oct 1, 2016 Accepting new patients
Icahn School of Medicine at Mount Sinai Past Accepting new patients

Locations

1249 5th Ave
New York, NY 10029
Phone (212) 360-1000

150 E 42nd St
Fl 10
New York, NY 10017
Phone (646) 605-8119

5 E 98th St
New York, NY 10029
Phone (212) 241-3986

Networks

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1387929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474502400000",
    "number": "1316368061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L LEVY PL",
            "address_2": "BOX 3000",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296504",
            "telephone_number": "212-987-3100",
            "fax_number": "212-731-5210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1249 5TH AVENE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10029",
            "telephone_number": "212-360-3734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "LILI",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-25",
        "last_updated": "2016-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "275737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.