Individual provider Active NPI

Jason Guanlao Rejano, D.C.

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1770924276
Registry record updated Jul 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.012469 Issued in IL
Practice address
118 S Clinton St
Chicago, IL 60661-3628
Phone
(312) 548-8498
Fax
(312) 548-8497
NPI assigned
Jul 12, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038.012469 IL Primary

Addresses

Primary practice location

118 S Clinton St
Chicago, IL 60661-3628

Mailing address

1071 W 15TH St
Unit 309
Chicago, IL 60608-3724
Phone (847) 903-1835

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160829000689 IL Practitioner - Chiropractic 1759676802 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Active Wellness LLCGroup PAC ID 3072752864, 21 clinicians

Practice addresses (Care Compare)

4555 N Lincoln Ave
Chicago, IL 60625-2102
Phone (847) 791-7012

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038.012469ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Active Wellness, LLC Chiropractor Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469923200000",
    "number": "1770924276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1071 W 15TH ST",
            "address_2": "UNIT 309",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606083724",
            "telephone_number": "847-903-1835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 S CLINTON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606613628",
            "telephone_number": "312-548-8498",
            "fax_number": "312-548-8497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REJANO",
        "first_name": "JASON",
        "middle_name": "GUANLAO",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-12",
        "last_updated": "2016-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.012469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.