Active NPI
Johnmer Manandeg Chan, PT
- Physical Therapist
- San Bruno, CA
National Provider Identifier
1609164599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 37300
- Practice address
- 3825 Adriatic Way
San Bruno, CA 94066-4552 - Phone
- (650) 355-0226
- NPI assigned
- Jul 13, 2011
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 37300 | CA | Primary |
Addresses
Primary practice location
3825 Adriatic Way
San Bruno, CA 94066-4552
Mailing address
3825 Adriatic Way
San Bruno, CA 94066-4552
Phone (650) 355-0226
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT 37300 | Other | CA | PT LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 37300 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abbacare at Home Corp | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Home Health Agency
- Sacramento, CA
- NPI 1275269888
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310515200000",
"number": "1609164599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3825 ADRIATIC WAY",
"city": "SAN BRUNO",
"state": "CA",
"postal_code": "940664552",
"telephone_number": "650-355-0226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3825 ADRIATIC WAY",
"city": "SAN BRUNO",
"state": "CA",
"postal_code": "940664552",
"telephone_number": "650-355-0226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "JOHNMER",
"middle_name": "MANANDEG",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-07-13",
"last_updated": "2011-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT 37300",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE",
"identifier": "PT 37300",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Bruno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.