Individual provider Active NPI

Ji Jill Chen, M.D.

  • Internal Medicine Physician
  • Berkeley, CA
National Provider Identifier
1386685444
Registry record updated Feb 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A80978 Issued in CA
Practice address
3260 Sacramento St
Over 60 Health Center
Berkeley, CA 94702-2739
Phone
(510) 601-6060
NPI assigned
Jun 9, 2006
Last updated
Feb 8, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A80978 CA Primary

Addresses

Primary practice location

3260 Sacramento St
Over 60 Health Center
Berkeley, CA 94702-2739

Mailing address

3260 Sacramento St
Over 60 Health Center
Berkeley, CA 94702-2739
Phone (510) 601-6060

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20050802000710 CA Practitioner - Internal Medicine 1850329608 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifelong Medical CareGroup PAC ID 2062304538, 75 clinicians

Practice addresses (Care Compare)

3260 Sacramento St
Berkeley, CA 94702-2739
Phone (510) 428-4500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
80978CAMDPharmacist
A80978CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifelong Medical Care CurrentSince Dec 31, 2014 Accepting new patients
Lifelong Medical Care CurrentSince Dec 31, 2014 Accepting new patients

Locations

2344 6th St
Berkeley, CA 94710
Phone (510) 981-3203

3260 Sacramento St
Berkeley, CA 94702
Phone (510) 428-4500

3260 Sacramento St
#60
Berkeley, CA 94702
Phone (510) 428-4519

10700 MacArthur Blvd
Ste 14B
Oakland, CA 94605
Phone (510) 563-4300

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jchen280509@direct.ochin.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328659200000",
    "number": "1386685444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3260 SACRAMENTO ST",
            "address_2": "OVER 60 HEALTH CENTER",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022739",
            "telephone_number": "510-601-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3260 SACRAMENTO ST",
            "address_2": "OVER 60 HEALTH CENTER",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022739",
            "telephone_number": "510-601-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEN",
        "first_name": "JI",
        "middle_name": "JILL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2012-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A80978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.