JACK CHEN MD
NPI 1104356500
Radiology - Diagnostic Radiology in Roseville, MN
About Jack Chen Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACK CHEN MD (NPI 1104356500) is an individual diagnostic radiology provider in Roseville, Minnesota, licensed in Minnesota (74190) and active in the NPI registry since June 2017. He is enrolled in Medicare PECOS, is affiliated with Lakeview Memorial Hospital, and is a graduate of Saint Louis University School Of Medicine (2017).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jack Chen Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
25Medicare enrollment records show Jack Chen reassigns Medicare billing to 25 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Roseville, MN 55113
- Reassigned Medicare billing, Minnesota and Wisconsin enrollments
- 218 clinicians in this Medicare group
Roseville, MN 55113
- Reassigned Medicare billing, Minnesota enrollment
- 219 clinicians in this Medicare group
Minneapolis, MN 55413
- Reassigned Medicare billing, Minnesota enrollment
- 2,302 clinicians in this Medicare group
Minneapolis, MN 55421
- Reassigned Medicare billing, Minnesota enrollment
- 3,633 clinicians in this Medicare group
Minneapolis, MN 55414
- Reassigned Medicare billing, Minnesota enrollment
- 1,453 clinicians in this Medicare group
Minneapolis, MN 55455
- Reassigned Medicare billing, Minnesota enrollment
- 1,662 clinicians in this Medicare group
St Paul, MN 55108
- Reassigned Medicare billing, Minnesota and Wisconsin enrollments
- Also billed through NPI 1023314804 (Minnesota), NPI 1205069325 (Wisconsin), NPI 1407395247 (Wisconsin)
- 2,609 clinicians in this Medicare group
Minneapolis, MN 55454
- Reassigned Medicare billing, Minnesota enrollment
- 4,038 clinicians in this Medicare group
Minneapolis, MN 55454
- Reassigned Medicare billing, Minnesota enrollment
- 2,373 clinicians in this Medicare group
Saint Paul, MN 55102
- Reassigned Medicare billing, Minnesota enrollment
- 218 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 39
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare 5
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Lakeview Memorial Hospital
Acute Care Hospitals · Stillwater, MNRegions Hospital
Acute Care Hospitals · Saint Paul, MNAmery Hospital & Clinic
Critical Access Hospitals · Amery, WIHudson Hospital
Critical Access Hospitals · Hudson, WIWestfields Hospital And Clinic
Critical Access Hospitals · New Richmond, WIPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55113 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
ROSEVILLE, MN 55113
ROSEVILLE, MN 55113
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jack Chen's NPI number?
The NPI number for Jack Chen is 1104356500. It was assigned to this individual provider in the NPPES registry on June 18, 2017.
Where is Jack Chen located?
Jack Chen practices at 2355 Hwy 36 W Ste. 100, Roseville, MN 55113. The listed phone number is (651) 292-2000.
What is Jack Chen's specialty?
The primary specialty registered for this NPI is Radiology, specializing in Diagnostic Radiology, with taxonomy code 2085R0202X.
Is Jack Chen enrolled in Medicare?
Yes. Jack Chen is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Jack Chen's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jack Chen reassigns Medicare benefits to 25 organizations: Midwest Radiology, PA (Roseville, MN), Suburban Imaging, LLC (Roseville, MN), Fairview Clinics (Minneapolis, MN), Fairview Express Care (Minneapolis, MN), University Of Minnesota Physicians (Minneapolis, MN) and 20 more organizations, listed in the Medicare section above. Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jack Chen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Jack Chen accept?
Health plans from Avera Health Plans and Blue Cross Blue Shield of North Dakota list Jack Chen as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
Is Jack Chen affiliated with any hospitals?
According to CMS data, Jack Chen is affiliated with Lakeview Memorial Hospital, Regions Hospital, Amery Hospital & Clinic, Hudson Hospital and Westfields Hospital And Clinic.
When was this NPI record last updated?
The NPPES record for Jack Chen was last updated on July 31, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jack Chen, MD · NPI 1104356500
Diagnostic Radiology physician in Roseville, Minnesota. Individual provider, active in the CMS NPPES registry since June 18, 2017.
## Identity
- **NPI:** 1104356500 (Entity type: Individual)
- **Enumerated:** June 18, 2017
- **Primary specialty:** Radiology - Diagnostic Radiology · taxonomy 2085R0202X
- **State license:** 74190 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 2355 HWY 36 W, STE. 100, Roseville, MN 55113
- **Phone:** (651) 292-2000
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 25 organizations under Medicare reassignment (form CMS-855R): Midwest Radiology, PA (NPI 1952307175, Roseville, MN); Suburban Imaging, LLC (NPI 1427008937, Roseville, MN); Fairview Clinics (NPI 1548718588, Minneapolis, MN); Fairview Express Care (NPI 1407834302, Minneapolis, MN); University Of Minnesota Physicians (NPI 1477598118, Minneapolis, MN); and 20 more · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Saint Louis University School Of Medicine, class of 2017
## Record status
- **NPPES last updated:** July 31, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1104356500) · Data from the CMS NPPES public registry.