JERRY CHAN (NPI# 1982928404) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982928404 |
| Entity Type | Individual |
| Full Name | JERRY CHAN |
| Credential | FNP-BC |
| Practice Address |
1425 N Randall Rd Elgin IL 60123-2300 |
| Mailing Address |
2100 Powell St Suite 900 Emeryville CA 94608-1826 |
| Practice Telephone | 8477429800 |
| Mailing Telephone | 5103502600 |
| Mailing Fax Number | 5108799100 |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2010-04-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 209008110 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1425 N RANDALL RD |
| City | ELGIN |
| State | IL |
| Zip Code | 60123-2300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356310163 | Northwest Suburban Imaging Associates, S.c. | Radiology | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2006-03-15 |
| 1740888221 | Sylvia Moreno | Nurse Practitioner | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2020-10-15 |
| 1336765064 | Mohammed Nabeel Hameed | Nurse Practitioner | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2020-06-18 |
| 1861014318 | Heather Rose Krusemark | Nurse Practitioner | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2020-05-07 |
| 1629699616 | Tiffany Ann Via | Nurse Practitioner | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2020-04-30 |
| 1669011342 | Ashley Krynski | Nurse Anesthetist, Certified Registered | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2019-12-30 |
| 1023650132 | Nicole Carpenter | Counselor | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2019-10-09 |
| 1326507963 | Karen Sue Mcgann | Occupational Therapy Assistant | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2019-03-13 |
| 1033676978 | Jaclyn Mastrangeli | Nurse Practitioner | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2019-02-27 |
| 1508368523 | Abby Chovanec | Nurse Anesthetist, Certified Registered | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2018-03-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629625736 | Edna Lopez | Social Worker | 1140 N. Mclean Blvd #1, Elgin, IL 60123 | 2019-08-22 |
| 1003472259 | Katelyn Lee O'connell | Counselor | 695 S. Sate Street, Elgin, IL 60123 | 2019-05-14 |
| 1598235152 | Katie Elizabeth Dwyer | Counselor | 695 S. State Street, Elgin, IL 60123 | 2018-11-27 |
| 1174002778 | James M Accetta | Counselor | 52 Surry Drive, Elgin, IL 60123 | 2018-08-14 |
| 1770086175 | Griswold Home Care | Adult Companion | 707 A Davis Road, Suite 203, Elgin, IL 60123 | 2018-03-12 |
| 1003315706 | Danielle Bryant | Nurse Practitioner | 745 Fletcher Dr Ste 101, Elgin, IL 60123 | 2018-02-08 |
| 1912421470 | Deborah Foshager | Counselor | 680 Shenandoah Trail, Elgin, IL 60123 | 2017-07-26 |
| 1760903470 | Miguel Camargo | Specialist/Technologist | 12 N Aldine St, Elgin, IL 60123 | 2017-07-03 |
| 1134658594 | David Sommer | Counselor | 1460 Umbdenstock Rd, Elgin, IL 60123 | 2017-06-08 |
| 1649719618 | Faheem Unisa Syed | Clinical Nurse Specialist | 1990 Larkin Ave., Elgin, IL 60123 | 2017-02-23 |
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| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013523711 | Tiffany Robinson | Nurse Practitioner | 50 S Grove Ave Unit 308, Elgin, IL 60120-6434 | 2020-09-17 |
| 1881171197 | Tina Perry | Nurse Practitioner | 87 N Airlite St Ste 100, Elgin, IL 60123-4986 | 2018-07-20 |
| 1003315706 | Danielle Bryant | Nurse Practitioner | 745 Fletcher Dr Ste 101, Elgin, IL 60123 | 2018-02-08 |
| 1497397707 | Melissa Caryn Lopez | Nurse Practitioner | 2130 Point Blvd Ste 900, Elgin, IL 60123-9214 | 2019-10-09 |
| 1760957302 | Amy Amarathithada | Nurse Practitioner | 745 Fletcher Dr Ste 202, Elgin, IL 60123-4749 | 2018-10-10 |
| 1548743388 | Hemali Kumar | Nurse Practitioner | 745 Fletcher Dr Ste 202, Elgin, IL 60123-4749 | 2018-09-07 |
| 1427549393 | Devika R Patel | Nurse Practitioner | 801 Villa St, Elgin, IL 60120 | 2018-05-25 |
| 1104329036 | Stephanie Sue Nagarwalla | Nurse Practitioner | 1600 N Randall Rd Ste 400, Elgin, IL 60123-7805 | 2018-03-16 |
| 1649780933 | Priyanka Patel | Nurse Practitioner | 2400 Big Timber Rd, Elgin, IL 60124-7835 | 2017-10-02 |
| 1609398973 | Amanda Palermo | Nurse Practitioner | 1425 N Randall Rd, Elgin, IL 60123-2300 | 2017-07-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.