Individual provider Active NPI

Jessica Anne Tang, MD

  • Otolaryngology Physician
  • Riverside, CA
National Provider Identifier
1033630892
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A199179 Issued in CA
Practice address
4646 Brockton Ave Ste 103
Riverside, CA 92506-0103
Phone
(909) 558-2824
NPI assigned
Jul 3, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MT213438 PA
Otolaryngology Physician 207Y00000X D93310 MD
Otolaryngology Physician 207Y00000X A199179 CA Primary
Otolaryngology Physician 207Y00000X U4948 TX

Addresses

Primary practice location

4646 Brockton Ave Ste 103
Riverside, CA 92506-0103

Mailing address

11234 Anderson St RM 2586a
Loma Linda, CA 92350-1716

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20241105000939 CA Practitioner - Otolaryngology 3476822115 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: General Surgery
Education
University of California, San Diego School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Faculty Physicians and Surgeons of LlusmGroup PAC ID 1153227814, 1,313 clinicians
Beaver Medical Group P CGroup PAC ID 0547164295, 251 clinicians

Practice addresses (Care Compare)

11234 Anderson St
Loma Linda, CA 92354-2804

11370 Anderson St
Loma Linda, CA 92354-3450

259 Terracina Blvd
Redlands, CA 92373-4847
Phone (909) 793-2634

26520 Cactus Ave
Moreno Valley, CA 92555-3927

26780 Barton Rd
Redlands, CA 92373-4308
Phone (909) 558-5174

28078 Baxter Rd
Murrieta, CA 92563-1402
Phone (909) 558-4000

3762 Tibbetts St
Riverside, CA 92506-2605
Phone (951) 686-2224

4646 Brockton Ave
Riverside, CA 92506-0103
Phone (909) 558-3111

File Number
Los Angeles, CA 90074-4701

Hospital & facility affiliations

  • Loma Linda University Medical Center Hospital, Loma Linda, CA, CCN 050327
  • Riverside Community Hospital Hospital, Riverside, CA, CCN 050022
  • Riverside University Health System-Medical Center Hospital, Moreno Valley, CA, CCN 050292
  • Redlands Community Hospital Hospital, Redlands, CA, CCN 050272

Merit-based Incentive Payment System (MIPS)

Final score
88.87 of 100Reported as group
Quality
72.13
Promoting interoperability
80
Improvement activities
40
Cost
77.36

Procedures performed for Medicare patients

ProcedureNumber of procedures
Laminectomy or laminotomy (partial removal of spine bones)1-10
Melanoma (skin cancer) excision12
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A199179CAMDOtolaryngology Physician
U4948TXMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sac Health System Otolaryngology CurrentSince Dec 18, 2024 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Oct 1, 2024 Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Sac Health System Otolaryngology CurrentSince Dec 18, 2024 Accepting new patients
Beaver Medical Group P C CurrentSince Oct 1, 2024 Accepting new patients
Centers for Family Medicine GP Current Accepting new patients
Beaver Medical Group P C CurrentSince Oct 1, 2024 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Oct 1, 2024 Accepting new patients
Sac Health System Current Accepting new patients
Cassidy Medical Group Inc. Current Accepting new patients
Faculty Physicians and Surgeons of Llusm PastSince Jan 26, 2025 Accepting new patients

Locations

81 Highland Springs Ave
Ste 103
Beaumont, CA 92223
Phone (909) 558-2830

12021 Jacaranda Ave
Hesperia, CA 92345
Phone (909) 558-4207

82934 Civic Center Dr
Indio, CA 92201
Phone (760) 477-0733

11234 Anderson St
Rm 2586A
Loma Linda, CA 92350
Phone (909) 558-7884

25845 Barton Rd
Ste F
Loma Linda, CA 92354
Phone (909) 558-2828

11370 Anderson St
Ste 2100
Loma Linda, CA 92354
Phone (909) 558-2824

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

26520 Cactus Ave
Ste 2021
Moreno Valley, CA 92555
Phone (951) 486-5700

28078 Baxter Rd
Ste 520
Murrieta, CA 92563

28078 Baxter Rd
Murrieta, CA 92563
Phone (951) 290-4000

259 Terracina Blvd
Redlands, CA 92373
Phone (909) 328-5400

1895 Orange Tree Ln
Ste 102
Redlands, CA 92374
Phone (909) 558-2600

2 W Fern Ave
Redlands, CA 92373
Phone (909) 335-4137

3762 Tibbetts St
Riverside, CA 92506
Phone (951) 686-2224

4646 Brockton Ave
Ste 103
Riverside, CA 92506
Phone (909) 558-2824

250 S G St
San Bernardino, CA 92410
Phone (909) 771-2990

1455 3rd Ave
Sn Bernrdno, CA 92408
Phone (909) 382-7146

44274 George Cushman Ct
Ste 208
Temecula, CA 92592
Phone (951) 501-4200

901 San Bernardino Rd
Ste 104
Upland, CA 91786
Phone (909) 542-2779

145 Thunder Dr
Vista, CA 92083
Phone (760) 630-5487

Interoperability endpoints

  • Direct secure messaging: jtang1228893@direct.llu.edu
  • Direct secure messaging: jtang25955@epiclp.direct-ci.com

Organizations & group practices 11

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1499040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1033630892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST RM 2586A",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923501716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 BROCKTON AVE STE 103",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925060103",
            "telephone_number": "909-558-2824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANG",
        "first_name": "JESSICA",
        "middle_name": "ANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-03",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "PA",
            "license": "MT213438",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MD",
            "license": "D93310",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A199179",
            "primary": true
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "U4948",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.