Individual provider Active NPI

Yieshan Melissa Chan, M.D.

  • Anesthesiology Physician
  • Jackson, MS
National Provider Identifier
1467644773
Registry record updated Jul 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4301090983 Issued in MI
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(601) 815-4775
Fax
(601) 984-6451
NPI assigned
Aug 10, 2007
Last updated
Jul 9, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4301090983 MI Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (601) 851-5477

Other identifiers 2

IdentifierTypeStateIssuer
04778891MedicaidMS
2366653MedicaidLA

Other names 1

  • Dr. Yie Shan Chan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20130314000313 MS Practitioner - Anesthesiology 1557451374 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Texas Tech University Health Science Center School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Perioperative Services of Mississippi, LLCGroup PAC ID 8921365255, 98 clinicians

Practice addresses (Care Compare)

1225 N State St
Ms Baptist Medical Center
Jackson, MS 39202-2064
Phone (601) 317-2802

350 Crossgates Blvd
Brandon, MS 39042-2601
Phone (604) 317-2802

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301090983MIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jan 7, 2013 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jan 7, 2013 Accepting new patients
Perioperative Services of Mississippi, LLC Anesthesiology CurrentSince Nov 4, 2019 Accepting new patients
Guardian Anesthesia Services, PC Anesthesiology Past Accepting new patients

Locations

350 Crossgates Blvd
Brandon, MS 39042
Phone (601) 824-8500

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404864000000",
    "number": "1467644773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-851-5477",
            "fax_number": "601-984-6451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-4775",
            "fax_number": "601-984-6451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "YIESHAN",
        "middle_name": "MELISSA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-10",
        "last_updated": "2014-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301090983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04778891",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2366653",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "YIE",
            "last_name": "CHAN",
            "middle_name": "SHAN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

Verify at the official NPI Registry.