Active NPI
Jacqueline Phan
- Student in an Organized Health Care Education/Training Program
- Las Vegas, NV
National Provider Identifier
1487413860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 9260 W Sunset Rd Ste 110
Las Vegas, NV 89148-4903 - Phone
- (702) 916-6902
- NPI assigned
- Mar 18, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
9260 W Sunset Rd Ste 110
Las Vegas, NV 89148-4903
Mailing address
9260 W Sunset Rd Ste 110
Las Vegas, NV 89148-4903
Phone (702) 916-6902
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- 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 |
|---|---|---|---|---|
| I20240710005249 | NV | Order and Referring Only - Family Practice | 2769927052 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- jphan718838@direct.ochin.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1710720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715558400000",
"number": "1487413860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9260 W SUNSET RD STE 110",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891484903",
"telephone_number": "702-916-6902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9260 W SUNSET RD STE 110",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891484903",
"telephone_number": "702-916-6902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "JACQUELINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-18",
"last_updated": "2024-05-13",
"certification_date": "2024-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.