Jan Lei Iwata, DO

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

License

036-105234 Issued in IL

Practice address

1 E Superior St
307
Chicago, IL 60611-2507

Phone

(773) 501-7394

Fax

(773) 296-7787

NPI assigned

Nov 7, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389139200000",
    "number": "1922177351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 N CLARENDON AVE",
            "address_2": "1202",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405710",
            "telephone_number": "773-501-7394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 E SUPERIOR ST",
            "address_2": "307",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112507",
            "telephone_number": "773-501-7394",
            "fax_number": "773-296-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IWATA",
        "first_name": "JAN",
        "middle_name": "LEI",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-07",
        "last_updated": "2014-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "CA",
            "license": "7541",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "7541",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "CA",
            "license": "7541",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036-105234",
            "primary": false
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "IL",
            "license": "036-105234",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "IL",
            "license": "036-105234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "01632904",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin Marie Ivy, NP
• Sherann Ivy, APRN-FPA
• Elsa Chiyo A Iwai
• Khattab Iwainat, DPT
• Diana O. Iwanik, MD
• Suzanne Iwaz, M.D.
• Iwona Sobczak MD, SC
• Jennifer F Iwuchukwu, CNM
• Iyad M Alkhouri MD
• Esther Iyanobor, MD-MPH, CHES

• Public Health & General Preventive Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Public Health & General Preventive Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; 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.