Individual provider Active NPI

Jennifer Phan

  • Gastroenterology Physician
  • Newport Beach, CA
National Provider Identifier
1780002055
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
A141019 Issued in CA
Practice address
1 Hoag Dr
Newport Beach, CA 92663-4162
Phone
(949) 764-6943
NPI assigned
Apr 2, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X A141019 CA
Gastroenterology Physician 207RG0100X A141019 CA Primary

Addresses

Primary practice location

1 Hoag Dr
Newport Beach, CA 92663-4162

Mailing address

500 Superior Ave Ste 100
Newport Beach, CA 92663-3660
Phone (949) 764-8379

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20181115003133 CA Practitioner - GastroenterologyPractitioner - HospitalistPractitioner - Internal Medicine 9335493048 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Hospitalist, Internal Medicine
Education
University of California, Geffen School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hoag ClinicGroup PAC ID 3274872064, 447 clinicians

Practice addresses (Care Compare)

1 Hoag Dr
Newport Beach, CA 92663-4162

1031 Avenida Pico
Suite 204
San Clemente, CA 92673-6352
Phone (949) 829-5533

500 Superior Ave
Suite 270
Newport Beach, CA 92663-3657
Phone (949) 791-3370

Hospital & facility affiliations

  • Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, CA, CCN 050224

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy22
Upper gastrointestinal (GI) endoscopy for acid reflux231

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A141019CAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hoag Clinic CurrentSince Jul 1, 2024 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Jul 1, 2021 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Jul 1, 2021 Accepting new patients
Hoag Hospital Past Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1500 San Pablo St
Los Angeles, CA 90033
Phone (323) 443-8500

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1520 San Pablo St
Ste 1000
Los Angeles, CA 90033
Phone (626) 457-5839

500 Superior Ave
Ste 100
Newport Beach, CA 92663
Phone (949) 706-3300

1 Hoag Dr
Newport Beach, CA 92663
Phone (877) 742-4624

1031 Avenida Pico
Ste 204
San Clemente, CA 92673
Phone (949) 829-5533

8700 Beverly Blvd
West Hollywood, CA 90048
Phone (310) 385-3291

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10944/brand/3/csg/1/fhir/r4
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 4

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 1

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": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1780002055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SUPERIOR AVE STE 100",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633660",
            "telephone_number": "949-764-8379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOAG DR",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926634162",
            "telephone_number": "949-764-6943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-02",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A141019",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A141019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.