Jerry Fan, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

S4629 Issued in TX

Practice address

2401 S 31St St
Temple, TX 76508-0001

Phone

(254) 724-2111

Fax

(254) 724-7603

NPI assigned

Jun 1, 2017

Last updated

Jul 25, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Cardiovascular Disease (Cardiology)

Education

Texas Tech University Health Science Center School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baylor Scott & White Medical Center - Temple Hospital, Temple, TX, CCN 450054
• Baylor Scott & White Medical Center - Round Rock Hospital, Round Rock, TX, CCN 670034
• Baylor Scott & White Medical Center Hillcrest Hospital, Waco, TX, CCN 450101
• Coryell Memorial Hospital Hospital, Gatesville, TX, CCN 451379
• Adventhealth Central Texas Hospital, Killeen, TX, CCN 450152

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jfan283651@direct.sw.org

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.

• Scott & White Clinic

  dba Baylor Scott & White Clinic - Temple

  • Internal Medicine Physician
  • Temple, TX
  • NPI 1093779704
  Medicare reassignment Care Compare group NPD
• Scott & White Clinic

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1649820796
  NPD
• Scott & White Clinic

  • Internal Medicine Physician
  • College Station, TX
  • NPI 1922061993
  NPD
• Scott & White Hospital - Taylor

  dba Baylor Scott & White Medical Center - Taylor

  • Emergency Medicine Physician
  • Taylor, TX
  • NPI 1659366557
  NPD (past)

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

• Coryell County Memorial Hospital Authority

  dba Coryell Health

  • Critical Access Hospital
  • Gatesville, TX
  • NPI 1780823021
  Care Compare affiliation
• Hillcrest Baptist Medical Center

  dba Baylor Scott & White Medical Center Hillcrest

  • General Acute Care Hospital
  • Waco, TX
  • NPI 1891882833
  Care Compare affiliation
• Metroplex Adventist Hospital Inc

  dba AdventHealth Central Texas

  • General Acute Care Hospital
  • Killeen, TX
  • NPI 1629089966
  Care Compare affiliation
• Scott & White Hospital - Round Rock

  dba Baylor Scott & White Medical Center - Round Rock

  • General Acute Care Hospital
  • Round Rock, TX
  • NPI 1265568638
  Care Compare affiliation
• Scott & White Memorial Hospital

  dba Baylor Scott & White Medical Center - Temple

  • General Acute Care Hospital
  • Temple, TX
  • NPI 1477516466
  Care Compare affiliation
• Scott & White Memorial Hospital

  dba Kings's Daughters Hospital- Scott & White Healthcare

  • General Acute Care Hospital
  • Temple, TX
  • NPI 1578502613
  Care Compare affiliation

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

{
    "created_epoch": "1496275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1619405784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 S 31ST ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765080001",
            "telephone_number": "254-724-2111",
            "fax_number": "254-724-7603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "JERRY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-01",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "TX",
            "license": "S4629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jfan283651@direct.sw.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2401 S 31st St",
            "city": "Temple",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765080001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nadine Fahmy
• Wendy Fair, APRN, FNP-BC
• Patricia Mae Fajkus-Hogan, RN, FNP
• Family Hospice, LTD. (Gentiva)
• Jennifer Nielsen Fan, MD/MPH
• Stacy Leigh Fancher, PT
• Hannah Fang, P.A.
• Yi Fang
• Matthew Walker Fannell, M.D.
• Brian Patrick Fanning, CRNA

• Cardiovascular Disease Physician in Temple, TX
• Providers in Temple, TX by specialty
• Cardiovascular Disease Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.
• 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.