Jennifer R. Chan, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A92325 Issued in CA

Practice address

12618 Hawthorne Blvd.
Hawthorne, CA 90250-2325

Phone

(310) 263-5700

NPI assigned

Aug 10, 2006

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

Family Practice

Education

Ohio State University College of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Little Company of Mary Med Ctr Torrance Hospital, Torrance, CA, CCN 050353
• City of Hope Helford Clinical Research Hospital Hospital, Duarte, CA, CCN 050146

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1417915760
  Medicare reassignment Care Compare group NPD
• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1235182569
  NPD
• Axminster Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1538160098
  NPD (past)
• Prime Healthcare Centinela, LLC

  • General Acute Care Hospital
  • Inglewood, CA
  • NPI 1336328244
  NPD (past)
• Little Company of Mary Affiliated Services Inc

  • Internal Medicine Physician
  • Evergreen Park, IL
  • NPI 1588617260
  NPD (past)

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

• City of Hope National Medical Center

  • General Acute Care Hospital
  • Duarte, CA
  • NPI 1750358297
  Care Compare affiliation
• Providence Health System Southern California

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1902844988
  Care Compare affiliation

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1396756102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12618 HAWTHORNE BLVD.",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502325",
            "telephone_number": "310-263-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12618 HAWTHORNE BLVD.",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502325",
            "telephone_number": "310-263-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JENNIFER",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-10",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "MD12989",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A92325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "088054-01",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Century Eye Care Medical Center, Inc.
• Celine Heather Cerda, RN
• Chach Medical Aid
• Navneet Chagger, FDN-P
• Blair Marie Chambers, RN
• Robert Lance Charet, MD
• Charles L. Foster Jr. DDS Inc.
• Christine Chato, PHARMD
• Chaux & Gomez DDS Inc
• Erick Che

• Family Medicine Physician in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.