Jack Chan, MD

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

34672 Issued in NH

Practice address

101 Shattuck Way Ste 6
Newington, NH 03801-7876

Phone

(617) 372-4018

NPI assigned

Mar 26, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NH

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

Anesthesiology

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Specialty Institute PLLCGroup PAC ID 0941683551, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jack.chan.1@17350.direct.athenahealth.com

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.

• Specialty Institute PLLC

  • Interventional Pain Medicine Physician
  • Newington, NH
  • NPI 1932833621

  Anesthesiology

  Medicare reassignment Care Compare group NPD
• Pain Surgery Center Limited Liability Company

  • Ambulatory Surgical Clinic/Center
  • Newington, NH
  • NPI 1043955198
  Medicare reassignment NPD

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

{
    "created_epoch": "1585180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760486400000",
    "number": "1376170522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 SHATTUCK WAY STE 6",
            "city": "NEWINGTON",
            "state": "NH",
            "postal_code": "038017876",
            "telephone_number": "617-372-4018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 SHATTUCK WAY STE 6",
            "city": "NEWINGTON",
            "state": "NH",
            "postal_code": "038017876",
            "telephone_number": "617-372-4018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-26",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NH",
            "license": "34672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betsabe Bonilla
• Jonathan S Bridges, M.D.
• Marc P Brown, DDS
• Shannon Brown
• Isabelle Cerundolo, OTR
• Nicole Chetsas
• CJ Physical Therapy and Wellness, LLC
• Christine Clarke-Swift
• Coastal Surgical Center, LLC
• Erin E Conlan, MS ED, BCBA

• Pain Medicine (Anesthesiology) Physician in Newington, NH
• Providers in Newington, NH by specialty
• Pain Medicine (Anesthesiology) Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.
• 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.