Active NPI
Jacky Tran
- Family Medicine Physician
- Berwyn, IL
National Provider Identifier
1770267635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 125.084402
- Practice address
- 3249 Oak Park Ave
Berwyn, IL 60402-3429 - Phone
- (708) 783-9100
- NPI assigned
- Jun 12, 2023
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 125.084402 | IL | Primary |
Addresses
Primary practice location
3249 Oak Park Ave
Berwyn, IL 60402-3429
Mailing address
3249 Oak Park Ave
Berwyn, IL 60402-3429
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- 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 |
|---|---|---|---|---|
| I20240723001346 | IL | Order and Referring Only - Family Practice | 3072059344 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125.084402 | IL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718064000000",
"number": "1770267635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3249 OAK PARK AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3249 OAK PARK AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023429",
"telephone_number": "708-783-9100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAN",
"first_name": "JACKY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-12",
"last_updated": "2024-06-11",
"certification_date": "2024-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "125.084402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.