Jacqueline W.L. Chan, M.D., PH.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

A92182 Issued in CA

Practice address

447 W Eaton Ave
Tracy, CA 95376-3420

Phone

(209) 830-4063

NPI assigned

Jul 10, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Neurology

Education

Other, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sutter Valley Medical FoundationGroup PAC ID 9830094515, 2,473 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Tracy Community Hospital Hospital, Tracy, CA, CCN 050313

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jchan22480@hisp.ehr.sutterhealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sutter Valley Medical Foundation

  dba Sutter Gould Medical Foundation

  • Multi-Specialty Clinic/Center
  • Modesto, CA
  • NPI 1669846986
  Medicare reassignment Care Compare group
• Sutter Gould Medical Foundation

  dba Dale Road Care Center

  • Family Medicine Physician
  • Modesto, CA
  • NPI 1326093360
  NPD (past)
• Sutter Regional Medical Foundation

  • Family Medicine Physician
  • Fairfield, CA
  • NPI 1558388504

  Neurology

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sutter Valley Hospitals

  dba Sutter Tracy Community Hospital

  • General Acute Care Hospital
  • Tracy, CA
  • NPI 1821442864
  Care Compare affiliation

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274659200000",
    "number": "1801094032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-524-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "447 W EATON AVE",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953763420",
            "telephone_number": "209-830-4063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JACQUELINE",
        "middle_name": "W.L.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-10",
        "last_updated": "2010-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A92182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosemary Cervantes, MASTERS
• Traleca G. Chadwick
• Mandeep Kumar Chahal
• Ali Chakari, RVT, RVS
• Hailey Chamberjian
• Pearl Chan, MD
• Mridula Chandhoke
• Allen Chang, MD
• Nelson Yoium-Tsiu Chang, MD
• San-Miao Chang

• Neurology Physician in Tracy, CA
• Providers in Tracy, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2010; 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.