Betty Fan, D.O.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036.164960 Issued in IL

Practice address

5841 S Maryland Ave
Chicago, IL 60637-1443

Phone

(773) 702-1000

NPI assigned

Mar 26, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in MA, IN, IL3 enrollments

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 3

Specialty

General Surgery

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of ChicagoGroup PAC ID 7719899426, 1,674 clinicians

The University of Chicago Medical CenterGroup PAC ID 7618880766, 907 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The University of Chicago Medical Center Hospital, Chicago, IL, CCN 140088
• Uchicago Medicine Northwest Indiana Hospital, Crown Point, IN, CCN 150195

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bfan280310@uchospital.direct-ci.com

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.

• The University of Chicago Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1033218128
  Medicare reassignment Care Compare group NPD
• University of Chicago

  • Multi-Specialty Clinic/Center
  • Chicago, IL
  • NPI 1821048786

  IN

  Medicare reassignment Care Compare group NPD
• Beth Israel Deaconess Medical Center, Inc.

  • General Acute Care Hospital
  • Boston, MA
  • NPI 1548202641
  Medicare reassignment NPD
• University Surgeons, Inc.

  • Surgery Physician
  • Indianapolis, IN
  • NPI 1316966229
  Medicare reassignment NPD
• The University of Chicago Medical Center

  • Community/Retail Pharmacy
  • Calumet City, IL
  • NPI 1255895678
  NPD
• Beth Israel Deaconess Medical Center, Inc.

  • Ambulance
  • Boston, MA
  • NPI 1518600501
  NPD

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

• The University of Chicago Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1508956509
  Care Compare affiliation
• Uchicago Medicine Northwest Indiana Inc

  • General Acute Care Hospital
  • Crown Point, IN
  • NPI 1144914532
  Care Compare affiliation

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

{
    "created_epoch": "1364256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1669714895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 HARVESTER DR STE 300",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605275965",
            "telephone_number": "773-702-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371443",
            "telephone_number": "773-702-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "BETTY",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-26",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01083940A",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "34.013190",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036.164960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Familydoc Urgent Care LLC
• Familydok Urgent Care, LLC
• Annette Famulski
• Judy C. Fan-Hsu, D.D.S.
• Austin Fan, MD
• Eugene Fan, MD
• James Fan
• Yichen Fan, MD
• Fandom Behavioral Health Clinic PLLC
• Michael E. Fanelli, RN

• Surgery Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2023; 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.