NPIMap

Individual provider Active NPI

Lian Jen, DO PA

  • Physical Medicine & Rehabilitation Physician
  • Port Charlotte, FL
National Provider Identifier
1326031048
Registry record updated May 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
OS7724 Issued in FL
Practice address
3089 Tamiami Trail
Suite B
Port Charlotte, FL 33952
Phone
(941) 627-9768
Fax
(941) 627-2785
NPI assigned
Aug 28, 2005
Last updated
May 9, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X OS7724 FL Primary

Addresses

Primary practice location

3089 Tamiami Trail
Suite B
Port Charlotte, FL 33952

Mailing address

3089 Tamiami Trail
Suite B
Port Charlotte, FL 33952
Phone (941) 627-9768

Other identifiers 2

IdentifierTypeStateIssuer
49234OtherFLBCBS
273460500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20050909000208 FL Practitioner - Physical Medicine and RehabilitationPractitioner - Family Practice 9335171495 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Family Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3089 Tamiami TRL
B
Port Charlotte, FL 33952-8052
Phone (941) 627-9768

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lian Jen DO PA Physical Medicine & Rehabilitation CurrentSince Sep 11, 2006 Accepting new patients
Kraft Physical Therapy LLC PastSince Sep 11, 2006 Accepting new patients

Locations

3089 Tamiami Trl
#B
Pt Charlotte, FL 33952
Phone (941) 627-9768

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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

Hospital & facility affiliations 4

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": "1125187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368057600000",
    "number": "1326031048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3089 TAMIAMI TRAIL",
            "address_2": "SUITE B",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "33952",
            "telephone_number": "941-627-9768",
            "fax_number": "941-627-2785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3089 TAMIAMI TRAIL",
            "address_2": "SUITE B",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "33952",
            "telephone_number": "941-627-9768",
            "fax_number": "941-627-2785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEN",
        "first_name": "LIAN",
        "name_prefix": "Dr.",
        "credential": "DO PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-28",
        "last_updated": "2013-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "FL",
            "license": "OS7724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "49234",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273460500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.