Individual provider Active NPI

Christopher Tatum

  • Podiatrist
  • Los Angeles, CA
National Provider Identifier
1063908853
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
E5695 Issued in CA
Practice address
11301 Wilshire Blvd
Los Angeles, CA 90073-1003
Phone
(310) 478-3711
NPI assigned
Jul 5, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X E5695 CA Primary

Addresses

Primary practice location

11301 Wilshire Blvd
Los Angeles, CA 90073-1003

Mailing address

2100 Solar Dr
Ste 102
Oxnard, CA 93036-0649
Phone (805) 988-3338

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210921000177 CA Practitioner - Podiatry 4880091719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Western Un of HLTH Sciences, Col of Podiatric Med, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Foot and Ankle Concepts IncGroup PAC ID 5395770085, 10 clinicians

Practice addresses (Care Compare)

2100 Solar Dr
Suite 102
Oxnard, CA 93036-0649
Phone (805) 988-3338

Hospital & facility affiliations

  • Palmdale Regional Medical Center Hospital, Palmdale, CA, CCN 050204

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue185
Removal of skin lesions19
Removal of nail tissue834
Removal or shaving of skin growth561

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E5695CAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Foot & Ankle Concepts, Inc Podiatrist CurrentSince Aug 1, 2021 Accepting new patients

Locations

3901 Las Posas Rd
Ste 204
Camarillo, CA 93010
Phone (805) 383-2929

1739 W Avenue J
Lancaster, CA 93534
Phone (661) 940-0555

1672 W Avenue J
Ste 105
Lancaster, CA 93534
Phone (661) 249-6555

1672 W Avenue J
Ste 201
Lancaster, CA 93534
Phone (661) 945-3628

2100 Solar Dr
Ste 102
Oxnard, CA 93036
Phone (805) 650-8333

650 Commerce Ave
Ste D
Palmdale, CA 93551
Phone (661) 272-6898

3180 Willow Ln
Ste 108
Thousand Oaks, CA 91361
Phone (805) 370-3338

250 S Mills Rd
Ste 101
Ventura, CA 93003
Phone (805) 650-8333

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 1

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 1

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": "1530748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1063908853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 SOLAR DR",
            "address_2": "STE 102",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "930360649",
            "telephone_number": "805-988-3338",
            "fax_number": "805-830-1537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900731003",
            "telephone_number": "310-478-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATUM",
        "first_name": "CHRISTOPHER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-05",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E5695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.