NPIMap

Individual provider Active NPI

Peien Fan, M.D.

  • Neurology Physician
  • Mercer Island, WA
National Provider Identifier
1346504511
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD60752943 Issued in WA
Practice address
4736 91St Ave SE
Mercer Island, WA 98040-4440
Phone
(773) 703-6770
NPI assigned
Jul 2, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MD60752943 WA Primary

Addresses

Primary practice location

4736 91St Ave SE
Mercer Island, WA 98040-4440

Mailing address

4736 91St Ave SE
Mercer Island, WA 98040-4440
Phone (773) 703-6770

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20171120002622 WA Practitioner - Neurology 0941507461 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Neuromonitoring Associates, PCGroup PAC ID 8022019710, 30 clinicians

Practice addresses (Care Compare)

4736 91St Ave SE
Mercer Island, WA 98040-4440
Phone (734) 773-4314

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.73 of 100Reported as apm
Quality
73.46
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
American Neuromonitoring Associates, PC Neurology CurrentSince Sep 1, 2024 Accepting new patients
Overlake Medical Clinics LLC CurrentSince Oct 23, 2017 Accepting new patients
Overlake Medical Clinics, LLC CurrentSince Oct 23, 2017 Accepting new patients
Issaquah Obstetrics and Gynecology PLLC Past Accepting new patients
Memorial Hospital Inc Past Accepting new patients

Locations

10275 Little Patuxent Pkwy
Ste 300
Columbia, MD 21044
Phone (734) 545-4420

1135 116th Ave NE
Ste 500
Bellevue, WA 98004
Phone (425) 454-3938

1750 112th Ave NE
Ste B102
Bellevue, WA 98004
Phone (425) 688-5460

6520 226th Pl SE
Ste 150
Issaquah, WA 98027
Phone (425) 688-5777

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 and National Provider Directory roles.

Hospital & facility affiliations 29

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 29

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1341187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1346504511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4736 91ST AVE SE",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980404440",
            "telephone_number": "773-703-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4736 91ST AVE SE",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980404440",
            "telephone_number": "773-703-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "PEIEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-02",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "WA",
            "license": "MD60752943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mercer Island, WA

Sources for this page

Verify at the official NPI Registry.