Jerry Shih-Fan Yang, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9111984 Issued in FL

Practice address

12196 County Road 512
Fellsmere, FL 32948-5463

Phone

(772) 257-8224

Fax

(772) 213-3157

NPI assigned

Oct 6, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• John S Suen MD PA

  • Pulmonary Disease Physician
  • Vero Beach, FL
  • NPI 1891982179
  Medicare reassignment NPD

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

{
    "created_epoch": "1507248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653609600000",
    "number": "1841700523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 9TH ST SW",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329624312",
            "telephone_number": "772-257-8224",
            "fax_number": "772-213-3157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12196 COUNTY ROAD 512",
            "city": "FELLSMERE",
            "state": "FL",
            "postal_code": "329485463",
            "telephone_number": "772-257-8224",
            "fax_number": "772-213-3157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YANG",
        "first_name": "JERRY",
        "middle_name": "SHIH-FAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-06",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9111984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA9111984",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Treasure Coast Community Health Inc
• Treasure Coast Community Health Inc
• Treasure Coast Community Health Inc
• Ervin J Valcin, DMD
• Lindsey Worthen, FNP-C

• Medical Physician Assistant in Fellsmere, FL
• Providers in Fellsmere, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; 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.

Verify at the official NPI Registry.