Jennifer M Chan

Key facts

NPI

1891786471

Entity type

Individual (NPI type 1)

Primary specialty

Obstetrics & Gynecology Physician 207V00000X

License

036101112 (IL)

Practice address

250 Center Dr
Suite 101
Vernon Hills, IL 60061-1582

Phone

(847) 918-7050

Fax

(877) 796-4318

NPI assigned

Nov 2, 2005

Sex

Female

Sole proprietor

No

Organizations & group practices 3

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.

• Midwest Center for Women'S Health Care, LTD. Obstetrics & Gynecology Physician · Bannockburn, IL · NPI 1447200654
  Medicare reassignment Care Compare group IL
• Endeavor Health Medical Group Anesthesiology Physician · Evanston, IL · NPI 1265695944
  NPD (past)
• Endeavor Health Medical Group Emergency Medicine Physician · Evanston, IL · NPI 1497701882
  NPD (past) OBSTETRICS & GYNECOLOGY

Hospital & facility affiliations 3

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

• Advocate Condell Medical Center Mobile Mammography Clinic/Center · Gurnee, IL · NPI 1023262441
  Care Compare affiliation Hospital
• Advocate Condell Medical Center General Acute Care Hospital · Libertyville, IL · NPI 1124272547
  Care Compare affiliation Hospital
• Advocate Condell Medical Center Mobile Mammography Clinic/Center · Grayslake, IL · NPI 1770737199
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Obstetrics/Gynecology

Education

Northwestern University Feinberg Medical School, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midwest Center for Women'S Healthcare, LTD (93 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Advocate Condell Medical Center Hospital · Libertyville, IL · CCN 140202

Medicare participation

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: jennifer.chan.1@21117.direct.athenahealth.com

Specialties & licenses

Addresses

Other names

• Mrs. Jennifer M Serafin Other name

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 20, 2021.

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639958400000",
    "number": "1891786471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 LAKESIDE DR STE 209",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "600151271",
            "telephone_number": "847-562-1410",
            "fax_number": "847-562-0830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 CENTER DR",
            "address_2": "SUITE 101",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600611582",
            "telephone_number": "847-918-7050",
            "fax_number": "877-796-4318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "JENNIFER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036101112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jchan237677@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "250 Center Dr",
            "address_2": "Suite 101",
            "city": "Vernon Hills",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600611582",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicfhir.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "250 Center Dr",
            "address_2": "Suite 101",
            "city": "Vernon Hills",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600611582",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "SERAFIN",
            "middle_name": "M",
            "prefix": "MRS.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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All providers in Vernon Hills, IL · Obstetrics & Gynecology Physician in Illinois