Jacqueline Jiaqi Chan, - Medicare Nurse Practitioner in Gardena, CA

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Jacqueline Jiaqi Chan, is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" in Gardena, California. Her current practice location is 1225 W 190th St Ste 280, Gardena, California. You can reach out to her office (for appointments etc.) via phone at (877) 515-8113.

Jacqueline Jiaqi Chan is licensed to practice in California (license number 95025416) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1740988120.

Contact Information

Jacqueline Jiaqi Chan,
1225 W 190th St Ste 280,
Gardena, CA 90248-4305
(877) 515-8113
Not Available

Map and Direction




Provider's Profile

Full NameJacqueline Jiaqi Chan
GenderFemale
SpecialityNurse Practitioner - Psychiatric/mental Health
Location1225 W 190th St Ste 280, Gardena, California
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1740988120
  • Provider Enumeration Date: 02/16/2023
  • Last Update Date: 08/22/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 1658730585
  • Enrollment ID: I20230821003857

Medical Identifiers

Medical identifiers for Jacqueline Jiaqi Chan such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1740988120NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
163W00000XRegistered Nurse 95126081 (California)Secondary
363LP0808XNurse Practitioner - Psychiatric/mental Health 95025416 (California)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jacqueline Jiaqi Chan allows following entities to bill medicare on her behalf.
Entity NameAffiliated Psychological Services
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1750384350
PECOS PAC ID: 3779561378
Enrollment ID: O20040826001246
Entity NameEhab Yacoub Md Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1417373713
PECOS PAC ID: 5092099523
Enrollment ID: O20170301002071

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jacqueline Jiaqi Chan is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Jacqueline Jiaqi Chan,
16697 Tourmaline St,
Chino Hills, CA 91709-7435

Ph: () -		Jacqueline Jiaqi Chan,
1225 W 190th St Ste 280,
Gardena, CA 90248-4305

Ph: (877) 515-8113

Reviews and Comments


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Nnamdi Ferdinand Ofoeze,
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Practice Location: 1225 W 190th St Ste 280, Gardena, CA 90248
Phone: 310-515-8113    Fax: 310-538-2102

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.