Ian Pan, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

1024505 Issued in MA

Practice address

2825 Oak Lawn Ave Unit 192749
Dallas, TX 75219-4688

Phone

(510) 683-9500

Fax

(877) 880-2039

NPI assigned

Mar 24, 2020

Last updated

Sep 9, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

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

Specialty

Diagnostic Radiology

Education

Warren Alpert Medical School of Brown University, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Radiology Group IncGroup PAC ID 7113817149, 31 clinicians

Central Illinois Radiological Associates LTDGroup PAC ID 9436061827, 205 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pacific Radiology Group Inc

  • Specialist
  • Honolulu, HI
  • NPI 1871577536

  Diagnostic Radiology, MA

  Medicare reassignment Care Compare group NPD
• Central Illinois Radiological Associates, LTD.

  dba Central Illinois Radiological Associates

  • Diagnostic Radiology Physician
  • Peoria, IL
  • NPI 1538192828

  MA

  Medicare reassignment Care Compare group
• Blue Ridge Healthcare Medical Group Inc

  dba BRHC Radiology Practice

  • Diagnostic Radiology Physician
  • Morganton, NC
  • NPI 1639244478

  MA

  Medicare reassignment NPD
• St Agnes Healthcare Inc

  dba Integrated Specialists Group

  • Internal Medicine Physician
  • Baltimore, MD
  • NPI 1144250176

  MA

  Medicare reassignment NPD
• Sutter Valley Medical Foundation

  dba SGMF Radiology

  • Diagnostic Radiology Physician
  • Las Vegas, NV
  • NPI 1174997407

  MA

  Medicare reassignment NPD
• Osu Radiology LLC

  • Diagnostic Radiology Physician
  • Columbus, OH
  • NPI 1912956814

  MA

  Medicare reassignment
• Blue Ridge Healthcare Medical Group, Inc.

  dba Blue Ridge Transitional Care Clinic

  • Internal Medicine Physician
  • Morganton, NC
  • NPI 1578424685
  NPD
• St Agnes Healthcare Inc

  • Diagnostic Radiology Physician
  • Baltimore, MD
  • NPI 1780615922
  NPD
• Sutter Valley Medical Foundation

  • Durable Medical Equipment & Medical Supplies
  • Tracy, CA
  • NPI 1720930712
  NPD
• Sutter Valley Medical Foundation

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1952327256
  NPD
• Vision Radiology Professional Limited Liability Company

  • Specialist
  • Dallas, TX
  • NPI 1568819803
  NPD (past)

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1073140786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 OAK LAWN AVE UNIT 192749",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752194688",
            "telephone_number": "510-683-9500",
            "fax_number": "877-880-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 OAK LAWN AVE UNIT 192749",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752194688",
            "telephone_number": "510-683-9500",
            "fax_number": "877-880-2039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAN",
        "first_name": "IAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CT",
            "license": "86020",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301518665",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036.177005",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "1024505",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2025-02936",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Smitha Reddy Pamulaparthy, MD
• Amanda Pan
• Edward Pan, MD
• Elizabeth Runyu Pan
• Evelyn Tiffany Pan, MD
• Shannon Amy Pan, MD
• Thoris Pan, MD
• William Weifan Pan, MD
• Panacea Pharmacy LLC (Panacea RX Pharmacy)
• Panacea Therapy Solutions PLLC

• Diagnostic Radiology Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Diagnostic Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.