Dominique M. Jan, MD

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

250182 Issued in NY

Practice address

3355 Bainbridge Ave
Bronx, NY 10467-2801

Phone

(718) 920-7200

Fax

(718) 547-2929

NPI assigned

Jun 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: djan@montefioredirect.com
• Direct secure messaging: djan839228@nychhc.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.

• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152
  Medicare reassignment NPD
• Physician Affiliate Group of New York PC

  • Registered Dietitian
  • New York, NY
  • NPI 1013375526
  Medicare reassignment NPD
• Montefiore Medical Center

  • Community/Retail Pharmacy
  • Bronx, NY
  • NPI 1194183715
  NPD
• Trustees of Columbia University in the City of New York

  • Transplant Surgery Physician
  • New York, NY
  • NPI 1790739217
  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326931200000",
    "number": "1790726982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 BAINBRIDGE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672801",
            "telephone_number": "718-920-7200",
            "fax_number": "718-547-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 BAINBRIDGE AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672801",
            "telephone_number": "718-920-7200",
            "fax_number": "718-547-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAN",
        "first_name": "DOMINIQUE",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2012-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "NY",
            "license": "0024381",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "NY",
            "license": "250182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02729091",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Undine Jamison
• Heather Jamoona
• Jacob Jamron
• Rod Jamshidian, MD
• Kalsang Jamyang-Tshering, PSY.D
• Kung-Ming Jan, M.D.
• Mikaeel Ahmed Jan, MD
• Raj Janampally
• Surabi Janardhan, PA-C
• Hrag Yervant Janbatian, MD

• Pediatric Surgery Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Pediatric Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; 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.