NPIMap

Individual provider Active NPI

Trevor Phan, MD

  • Internal Medicine Physician
  • Fallon, NV
National Provider Identifier
1104943356
Registry record updated Feb 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
12765 Issued in NV
Practice address
801 E Williams Ave
Fallon, NV 89406-3052
Phone
(702) 453-3799
Fax
(702) 453-5741
NPI assigned
Mar 23, 2007
Last updated
Feb 22, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 22, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 12765 NV Primary
Internal Medicine Physician 207R00000X 111505 CA

Addresses

Primary practice location

801 E Williams Ave
Fallon, NV 89406-3052

Mailing address

PO Box 17976
Reno, NV 89511-1034
Phone (702) 453-3799

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, CA, WA, CO4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20080826000337 NV Practitioner - Internal Medicine 7113092131 Reassigns benefits to 1 organization
I20140723001353 CA Practitioner - Internal Medicine 7113092131 Reassigns benefits to 1 organization
I20230131001648 WA Practitioner - Internal Medicine 7113092131 Reassigns benefits to 1 organization
I20240404004332 CO Practitioner - Internal Medicine 7113092131 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1375 University St
Healdsburg, CA 95448-3382
Phone (707) 431-6500

1501 E 3Rd St
Delta, CO 81416-2815
Phone (970) 874-7681

520 N 4TH Ave
Pasco, WA 99301-5257
Phone (509) 547-7704

801 E Williams Ave
Fallon, NV 89406-3052
Phone (775) 423-3151

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
111505CAMDPediatric Dentist
12765NVMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Usacs Integrated Acute Care Services of Nevada Bagnoli P C Past Accepting new patients
Delta County Memorial Hospital Internal Medicine Past Accepting new patients
Lourdes Hospital LLC Past Accepting new patients
Lourdes Hospital LLC Past Accepting new patients

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456099200000",
    "number": "1104943356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17976",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895111034",
            "telephone_number": "702-453-3799",
            "fax_number": "702-453-5741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E WILLIAMS AVE",
            "city": "FALLON",
            "state": "NV",
            "postal_code": "894063052",
            "telephone_number": "702-453-3799",
            "fax_number": "702-453-5741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "TREVOR",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2016-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "12765",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "111505",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fallon, NV

Sources for this page

Verify at the official NPI Registry.