Tida Lam, D.O

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

271164 Issued in MA

Practice address

1964 S Main St
Wake Forest, NC 27587

Phone

(919) 554-0177

Fax

(919) 554-9277

NPI assigned

Jun 17, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Family Practice

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Avance Care PAGroup PAC ID 3577634476, 244 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tlam35162@fastmed.direct-ci.com
• FHIR API: https://fhir4.healow.com/fhir/r4/BEHABA

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.

• Avance Care, PA

  • Clinic/Center
  • Fuquay Varina, NC
  • NPI 1487845020
  Medicare reassignment Care Compare group NPD
• Roxboro Medical Associates, P.a.

  • Internal Medicine Physician
  • Roxboro, NC
  • NPI 1427156447
  NPD (past)

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

{
    "created_epoch": "1402963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557187200000",
    "number": "1114331204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10900 WORLD TRADE BLVD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276174202",
            "telephone_number": "630-740-0574",
            "fax_number": "603-228-7307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1964 S MAIN ST",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "27587",
            "telephone_number": "919-554-0177",
            "fax_number": "919-554-9277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "135 Jackson St",
            "address_purpose": "LOCATION",
            "city": "Lowell",
            "state": "MA",
            "postal_code": "018522103",
            "country_code": "US",
            "telephone_number": "978-937-9700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1964 S Main St",
            "address_purpose": "LOCATION",
            "city": "Wake Forest",
            "state": "NC",
            "postal_code": "275879336",
            "country_code": "US",
            "telephone_number": "919-554-0177",
            "fax_number": "919-554-9277",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAM",
        "first_name": "TIDA",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-17",
        "last_updated": "2019-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "271164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John F Kubiak, LMFT
• Chloe Eileen Kurst, OTR/L
• L. Brett Wells DDS VI PLLC (Wells Family Dental Group- Gateway Commons)
• Laboratory Corporation of America Holdings
• Julie Marie Lajoe, LPC
• Kimberly Jo Lampe, OTR
• Joshua Mark Metzger Lancaster, MD
• Michelle Wotring Landis, PT, DPT
• Lane and Associates LV DDS PA
• Jennifer Anne Lane Lehr, M.S. CCC-SLP

• Family Medicine Physician in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2019; 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.