Individual provider Active NPI

Djerrick Cu Tan, M.D.

  • Diagnostic Radiology Physician
  • Mequon, WI
National Provider Identifier
1124002654
Registry record updated Feb 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
47802 Issued in WI
Practice address
10945 N Port Washington Rd Ste 201
Mequon, WI 53092-5078
Phone
(262) 292-3151
NPI assigned
Nov 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 1025471 MA
Diagnostic Radiology Physician 2085R0202X MD20361 RI
Diagnostic Radiology Physician 2085R0202X 47802 WI Primary

Addresses

Primary practice location

10945 N Port Washington Rd Ste 201
Mequon, WI 53092-5078

Mailing address

10945 N Port Washington Rd Ste 201
Mequon, WI 53092-5078
Phone (262) 292-3151

Other practice location 1

450 Veterans Memorial Pkwy Bldg 2
East Providence, RI 02914-5300
Phone (401) 435-3041

Other practice location 2

211 Park St
Attleboro, MA 02703-3143
Phone (508) 222-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, TN, IL3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20050308001119 WI Practitioner - Diagnostic Radiology 1557315991 Reassigns benefits to 6 organizations
I20181109002547 TN Practitioner - Diagnostic Radiology 1557315991 Reassigns benefits to 3 organizations
I20231218001154 IL Practitioner - Diagnostic Radiology 1557315991 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Indiana University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Radiology Wisconsin LLCGroup PAC ID 9537595533, 111 clinicians

Practice addresses (Care Compare)

10101 S 27TH St
Franklin, WI 53132-7209
Phone (414) 325-4700

10180 Washington Ave
Mount Pleasant, WI 53177-1604
Phone (414) 973-7830

10950 W Capitol Dr
Wauwatosa, WI 53222-1110
Phone (414) 464-4460

12831 N Port Washington Rd
Mequon, WI 53097-2416
Phone (414) 973-7844

13111 N Port Washington Rd
Mequon, WI 53097-2416
Phone (262) 243-7300

13950 W Capitol Dr
Brookfield, WI 53005-2441
Phone (414) 302-5400

19333 W N Ave
Brookfield, WI 53045-4132
Phone (262) 785-2000

2061 Cheyenne CT
Grafton, WI 53024-9368
Phone (262) 376-1934

2301 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 585-1000

3237 S 16TH St
Milwaukee, WI 53215-4526
Phone (414) 647-5000

375 W River Woods Pkwy
Glendale, WI 53212-1080
Phone (414) 973-7842

3801 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-4011

3807 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-8300

3811 Spring St
Mount Pleasant, WI 53405-1667
Phone (262) 687-5300

4935 S 76TH St
Greenfield, WI 53220-4305
Phone (414) 973-7846

5000 W Chambers St
Milwaukee, WI 53210-1650
Phone (414) 447-2000

788 N Jefferson St
Milwaukee, WI 53202-3718
Phone (414) 272-8950

801 S 70TH St
West Allis, WI 53214-3147
Phone (414) 773-6600

9252 N Green Bay Rd
Brown Deer, WI 53209-1104
Phone (414) 270-8150

N112W15415 Mequon Rd
Germantown, WI 53022-3410
Phone (262) 250-7800

N143W6515 Pioneer Rd
Cedarburg, WI 53012-2705
Phone (262) 377-6933

Hospital & facility affiliations

  • Ascension Columbia St Marys Hospital Milwaukee Hospital, Milwaukee, WI, CCN 520051
  • Ascension All Saints Hospital Hospital, Racine, WI, CCN 520096
  • Ascension SE Wisconsin Hospital Hospital, Milwaukee, WI, CCN 520136
  • Ascension St Francis Hospital Hospital, Milwaukee, WI, CCN 520078

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1025471MAMDDiagnostic Radiology Physician
MD20361RIMDDiagnostic Radiology Physician
47802WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group-Southeast Wisconsin Inc Diagnostic Radiology CurrentSince Sep 1, 2008 Accepting new patients
Advanced Diagnostic Imaging PC CurrentSince Dec 3, 2018 Accepting new patients
Precision Radiology - Illinois LTD CurrentSince Feb 1, 2023 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee Inc CurrentSince Apr 1, 2010 Accepting new patients
Medical X-Ray Consultants, LTD Diagnostic Radiology CurrentSince Oct 19, 2025 Accepting new patients
Premier Radiology Wisconsin, LLC Diagnostic Radiology CurrentSince Jan 20, 2020 Accepting new patients
Advanced Diagnostic Imaging, PC Diagnostic Radiology CurrentSince Dec 3, 2018 Accepting new patients
Middle Tennessee Imaging LLC Diagnostic Radiology CurrentSince Dec 3, 2018 Accepting new patients
Columbia St. Mary'S Hospital Milwaukee, Inc CurrentSince Apr 1, 2010 Accepting new patients
Nol, LLC Diagnostic Radiology CurrentSince Dec 3, 2018 Accepting new patients
Wisconsin Radiology Specialists, S C CurrentSince Jul 1, 2005 Accepting new patients
Rhode Island Medical Imaging Inc Diagnostic Radiology Past Accepting new patients
Aurora Advanced Healthcare Inc Past Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. Past Accepting new patients
Medical Scanning Consultants, P.a. Diagnostic Radiology Past Accepting new patients
Medical Xray Consultants, LTD PastSince May 16, 2021 Accepting new patients

Locations (25 of 33)

7435 W Talcott Ave
Chicago, IL 60631
Phone (773) 467-9977

2900 N Lakeshore
Chicago, IL 60657
Phone (773) 665-3240

100 N River Rd
Des Plaines, IL 60016
Phone (847) 297-1800

205 S Northwest Hwy
Park Ridge, IL 60068
Phone (224) 585-7000

3024 Business Park Cir
Goodlettsvlle, TN 37072
Phone (615) 239-2018

1210 Briarville Rd
Bldg F602
Madison, TN 37115
Phone (615) 773-7237

28 White Bridge Pike
Ste 111
Nashville, TN 37205
Phone (615) 986-6153

3443 Dickerson Pike
Ste 400
Nashville, TN 37207
Phone (615) 612-2146

13950 W Capitol Dr
Brookfield, WI 53005
Phone (414) 302-5400

900 W Clairemont Ave
Eau Claire, WI 54701
Phone (715) 717-4121

7400 W Rawson Ave
Ste G40
Franklin, WI 53132
Phone (414) 282-5314

N112W15415 Mequon Rd
Germantown, WI 53022
Phone (262) 250-7800

6900 N Port Washington Rd
Glendale, WI 53217
Phone (414) 270-8100

7080 N Port Washington Rd
Glendale, WI 53217
Phone (414) 228-4940

6080 S 108th St
Hales Corners, WI 53130
Phone (414) 282-5314

12800 N Port Washington Rd
Mequon, WI 53097
Phone (262) 243-3655

13133 N Port Washington Rd
Mequon, WI 53097
Phone (262) 243-5850

2025 W Oklahoma Ave
Ste 121
Milwaukee, WI 53215
Phone (414) 671-1711

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204

500 W Brown Deer Rd
Ste 202
Milwaukee, WI 53217

2323 N Lake Dr
Milwaukee, WI 53211
Phone (414) 291-1000

2745 W Layton Ave
Ste 206
Milwaukee, WI 53221
Phone (414) 281-9665

10180 Washington Ave
Mount Pleasant, WI 53177
Phone (414) 769-4040

1317 W Grand Ave
Prt Washingtn, WI 53074
Phone (262) 268-6998

830 E Green Bay Ave
Saukville, WI 53080
Phone (262) 284-7117

Organizations & group practices 16

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.

View all 16

Hospital & facility affiliations 5

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": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771804800000",
    "number": "1124002654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10945 N PORT WASHINGTON RD STE 201",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925078",
            "telephone_number": "262-292-3151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10945 N PORT WASHINGTON RD STE 201",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925078",
            "telephone_number": "262-292-3151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 Veterans Memorial Pkwy Bldg 2",
            "address_purpose": "LOCATION",
            "city": "East Providence",
            "state": "RI",
            "postal_code": "029145300",
            "country_code": "US",
            "telephone_number": "401-435-3041",
            "fax_number": "401-435-3042",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "211 Park St",
            "address_purpose": "LOCATION",
            "city": "Attleboro",
            "state": "MA",
            "postal_code": "027033143",
            "country_code": "US",
            "telephone_number": "508-222-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "DJERRICK",
        "middle_name": "CU",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "1025471",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "RI",
            "license": "MD20361",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "47802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

Verify at the official NPI Registry.