Jennifer Jen-Wei Wan, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

A128087 Issued in CA

Practice address

100 S San Mateo Dr
San Mateo, CA 94401-3805

Phone

(650) 696-4515

Fax

(650) 696-4626

NPI assigned

Mar 20, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Diagnostic Radiology

Education

University of California, San Diego School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

California Advanced Imaging Medical Associates IncGroup PAC ID 0244144228, 85 clinicians

Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

County of San MateoGroup PAC ID 9032023171, shared by 15 NPIs, 316 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peninsula Medical Center Hospital, Burlingame, CA, CCN 050007
• San Mateo Medical Center Hospital, San Mateo, CA, CCN 050113
• Sutter Lakeside Hospital Hospital, Lakeport, CA, CCN 051329
• Ahmc Seton Medical Center Hospital, Daly City, CA, CCN 050289
• UCSF Medical Center Hospital, San Francisco, CA, CCN 050454

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 29)

Interoperability endpoints

• Direct secure messaging: jwan19712@smch.direct-ci.com
• Direct secure messaging: jwan375979@hisp.ehr.sutterhealth.org

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.

• California Advanced Imaging Medical Associates Inc

  • Diagnostic Radiology Physician
  • San Francisco, CA
  • NPI 1881646909
  Medicare reassignment Care Compare group NPD
• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Palo Alto, CA
  • NPI 1013950807
  Medicare reassignment Care Compare group NPD
• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1679642326
  Medicare reassignment NPD
• County of San Mateo

  • Multi-Specialty Clinic/Center
  • San Mateo, CA
  • NPI 1831268580
  Medicare reassignment NPD
• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986

  Diagnostic Radiology

  Medicare reassignment NPD
• County of San Mateo

  • Community/Behavioral Health Agency
  • Redwood City, CA
  • NPI 1528432481
  NPD
• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1003267196
  NPD
• Sutter Bay Medical Foundation

  • Clinical Medical Laboratory
  • Santa Clara, CA
  • NPI 1669287033
  NPD
• Sutter Valley Medical Foundation

  • Durable Medical Equipment & Medical Supplies
  • Tracy, CA
  • NPI 1720930712
  NPD
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Burlingame, CA
  • NPI 1043670334
  NPD (past)
• Sutter Bay Hospitals

  • Medicare Defined Swing Bed Hospital Unit
  • Lakeport, CA
  • NPI 1598098642
  NPD (past)
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • San Francisco, CA
  • NPI 1730238007
  NPD (past)

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

• Ahmc Seton Medical Center LLC

  • General Acute Care Hospital
  • Daly City, CA
  • NPI 1023636545
  Care Compare affiliation
• Ahmc Seton Medical Center LLC

  • Psychiatric Hospital Unit
  • Daly City, CA
  • NPI 1639797855
  Care Compare affiliation
• County of San Mateo

  • General Acute Care Hospital
  • San Mateo, CA
  • NPI 1003985755
  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Daly City, CA
  • NPI 1023196011

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Daly City, CA
  • NPI 1265522619

  Hospital

  Care Compare affiliation
• County of San Mateo

  • General Acute Care Hospital
  • San Mateo, CA
  • NPI 1386713030
  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Redwood City, CA
  • NPI 1386728533

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Redwood City, CA
  • NPI 1568540557

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • South San Francisco, CA
  • NPI 1750460671

  Hospital

  Care Compare affiliation
• County of San Mateo

  • Federally Qualified Health Center (FQHC)
  • Half Moon Bay, CA
  • NPI 1841379765

  Hospital

  Care Compare affiliation
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Burlingame, CA
  • NPI 1043670334
  Care Compare affiliation
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Menlo Park, CA
  • NPI 1295199701
  Care Compare affiliation

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

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1356616544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6102",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949486102",
            "telephone_number": "415-884-3415",
            "fax_number": "415-883-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S SAN MATEO DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944013805",
            "telephone_number": "650-696-4515",
            "fax_number": "650-696-4626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 W 39th Ave",
            "address_purpose": "LOCATION",
            "city": "San Mateo",
            "state": "CA",
            "postal_code": "944034364",
            "country_code": "US",
            "telephone_number": "650-573-2222",
            "fax_number": "650-573-2122",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 Trousdale Dr",
            "address_purpose": "LOCATION",
            "city": "Burlingame",
            "state": "CA",
            "postal_code": "940104506",
            "country_code": "US",
            "telephone_number": "650-696-4515",
            "fax_number": "650-696-5280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAN",
        "first_name": "JENNIFER",
        "middle_name": "JEN-WEI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-20",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CA",
            "license": "A128087",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A128087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356616544",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walnut Creek CBT Clinic
• Kristen Walsh, PA-C
• Lisa Walsh, DC
• Aaron Walter
• Kalie Marie Walton
• Maggie Wan
• Megan Wandel
• Angela Yungchieh Wang, DDS
• Elizabeth Wang, MD
• Ivy Wang

• Diagnostic Radiology Physician in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.