Active NPI
Shangjun Jiang
- Ophthalmology Physician
- Boston, MA
National Provider Identifier
1417795048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 1018563
- Practice address
- 243 Charles St
Boston, MA 02114-3002 - Phone
- (617) 523-7900
- NPI assigned
- Jul 17, 2024
- Last updated
- Aug 23, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 1018563 | MA | Primary |
Addresses
Primary practice location
243 Charles St
Boston, MA 02114-3002
Mailing address
243 Charles St
Boston, MA 02114-3096
Phone (617) 573-3288
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240903000442 | MA | Practitioner - Ophthalmology | 8820537012 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724371200000",
"number": "1417795048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "243 CHARLES ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021143096",
"telephone_number": "617-573-3288"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "243 CHARLES ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021143002",
"telephone_number": "617-523-7900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIANG",
"first_name": "SHANGJUN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-17",
"last_updated": "2024-08-23",
"certification_date": "2024-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MA",
"license": "1018563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.