Individual provider Active NPI

Kung-Ming Jan, M.D.

  • Cardiovascular Disease Physician
  • Bronx, NY
National Provider Identifier
1699752261
Registry record updated Sep 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
122967 Issued in NY
Practice address
3050 Corlear Ave
Suite 204
Bronx, NY 10463-5180
Phone
(718) 601-4800
Fax
(718) 601-6102
NPI assigned
Dec 27, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 122967 NY
Cardiovascular Disease Physician 207RC0000X 122967 NY Primary

Addresses

Primary practice location

3050 Corlear Ave
Suite 204
Bronx, NY 10463-5180

Mailing address

3050 Corlear Ave.
Suite 204
Bronx, NY 10463-5180
Phone (718) 601-4800

Other identifiers 1

IdentifierTypeStateIssuer
00592374MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20091019000107 NY Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 0446397814 Reassigns benefits to 1 organization
Practice locations: Bronx, NY; New York, NY

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Cardiovascular Disease (Cardiology)
Education
Other, 1967
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

161 Fort Washington Ave
New York, NY 10032-3729
Phone (718) 601-4800

3050 Corlear Ave
Suite 204
Bronx, NY 10463-5181
Phone (718) 601-4800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
30 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
122967NYMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trustees of Columbia University in the City of New York Internal Medicine CurrentSince Jan 1, 2002 Accepting new patients
Trustees of Columbia University in the Department of Otolaryngology Past Accepting new patients
Kmjan, LLC Internal Medicine Past Accepting new patients

Locations

3050 Corlear Ave
Ste 204
Bronx, NY 10463
Phone (718) 601-4800

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

5141 Broadway
New York, NY 10034
Phone (212) 932-4000

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

630 W 168th St
#4
New York, NY 10032
Phone (212) 305-6387

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348012800000",
    "number": "1699752261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3050 CORLEAR AVE.",
            "address_2": "SUITE 204",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104635180",
            "telephone_number": "718-601-4800",
            "fax_number": "718-601-6102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 CORLEAR AVE",
            "address_2": "SUITE 204",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104635180",
            "telephone_number": "718-601-4800",
            "fax_number": "718-601-6102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAN",
        "first_name": "KUNG-MING",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-27",
        "last_updated": "2012-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "122967",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "122967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00592374",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.