Active NPI
Austin Fan, MD
- Urology Physician
- Chicago, IL
National Provider Identifier
1346008109
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 125.086631
- Practice address
- 420 E Superior St Ste 9-900
Chicago, IL 60611-4494 - Phone
- (312) 503-7975
- NPI assigned
- Mar 7, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 125.086631 | IL | Primary |
Addresses
Primary practice location
420 E Superior St Ste 9-900
Chicago, IL 60611-4494
Mailing address
9500 Gilman Dr
La Jolla, CA 92093-0004
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250701002236 | IL | Order and Referring Only - Urology | 3375056575 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.086631 | IL | MD | Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1709769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750291200000",
"number": "1346008109",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9500 GILMAN DR",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920930004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 E SUPERIOR ST STE 9-900",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606114494",
"telephone_number": "312-503-7975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAN",
"first_name": "AUSTIN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-07",
"last_updated": "2025-06-19",
"certification_date": "2025-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "IL",
"license": "125.086631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.