Individual provider Active NPI

Jerry Yan, M.D

  • Cardiovascular Disease Physician
  • Rockford, IL
National Provider Identifier
1336595123
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036159837 Issued in IL
Practice address
1340 Charles St Ste 300
Rockford, IL 61104-2200
Phone
(779) 696-4400
NPI assigned
May 11, 2016
Last updated
Apr 25, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036159837 IL Primary

Addresses

Primary practice location

1340 Charles St Ste 300
Rockford, IL 61104-2200

Mailing address

1340 Charles St Ste 300
Rockford, IL 61104-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20230111000966 IL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 3971868332 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of Michigan Medical School, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Swedishamerican HospitalGroup PAC ID 5799698346, 386 clinicians

Practice addresses (Care Compare)

1340 Charles St
Rockford, IL 61104-2200

1401 E State St
Rockford, IL 61104-2315
Phone (815) 489-4400

1625 S State St
Belvidere, IL 61008-5907

1700 Henry Luckow LN
Belvidere, IL 61008-1702
Phone (779) 696-8650

380 E Il Route 38
Sa Rochelle
Rochelle, IL 61068-9694
Phone (779) 696-9050

6824 Newburg Rd
Sa Valley
Rockford, IL 61108-4330
Phone (779) 696-7610

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.51 of 100Reported as group
Quality
83.2
Promoting interoperability
77
Improvement activities
40
Cost
71.7

Merit-based Incentive Payment System (MIPS)

Final score
83.84 of 100Reported as group
Quality
75.22
Promoting interoperability
92
Improvement activities
40
Cost
73.11

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Swedishamerican Hospital CurrentSince Sep 16, 2022 Accepting new patients
Swedishamerican Hospital CurrentSince Sep 16, 2022 Accepting new patients
Freeport Memorial Hospital CurrentSince May 2, 2023 Accepting new patients
Freeport Regional Health Care Foundation CurrentSince May 2, 2023 Accepting new patients
Swedishamerican Hospital Cardiovascular Disease Current Accepting new patients

Locations

1036 W Stephenson St
Freeport, IL 61032
Phone (815) 599-7410

1045 W Stephenson St
Freeport, IL 61032
Phone (815) 599-6105

1340 Charles St
Ste 300
Rockford, IL 61104
Phone (779) 696-5888

2550 Charles St
Rockford, IL 61108
Phone (779) 696-7285

6824 Newburg Rd
Rockford, IL 61108
Phone (779) 696-7610

600 N Rush St
Stockton, IL 61085
Phone (815) 235-3165

Organizations & group practices 5

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": "1462924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1336595123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1340 CHARLES ST STE 300",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1340 CHARLES ST STE 300",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611042200",
            "telephone_number": "779-696-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAN",
        "first_name": "JERRY",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-11",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036159837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.