NPIMap

Individual provider Active NPI

Sidhartha Tan, MD

  • Neonatal-Perinatal Medicine Physician
  • Detroit, MI
National Provider Identifier
1154480630
Registry record updated Mar 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
4301109000 Issued in MI
Practice address
3901 Beaubien
Children'S Hospital of Mi
Detroit, MI 48201
Phone
(313) 745-4405
Fax
(313) 966-0665
NPI assigned
Dec 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301109000 MI
Neonatal-Perinatal Medicine Physician 2080N0001X 036068889 IL
Neonatal-Perinatal Medicine Physician 2080N0001X 4301109000 MI Primary

Addresses

Primary practice location

3901 Beaubien
Children'S Hospital of Mi
Detroit, MI 48201

Mailing address

4201 St. Antoine - Uhc 5D - #226
University Pediatricians
Detroit, MI 48201-2153
Phone (313) 745-4405

Other identifiers 2

IdentifierTypeStateIssuer
036068889OtherILSTATE LICENSE
4301109000OtherMISTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160309000298 MI Practitioner - Pediatric Medicine 9436347523 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036068889ILMDNeonatal-Perinatal Medicine Physician
4301109000MIMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Pediatricians Pediatrics CurrentSince Feb 4, 2016 Accepting new patients
University Pediatricians Pediatrics CurrentSince Feb 4, 2016 Accepting new patients
Pediatric Subspecialty Faculty, Inc. Pediatrics Past Accepting new patients
Endeavor Health Clinical Operations Past Accepting new patients
Northwestern Lake Forest Hospital Past Accepting new patients
Endeavor Health Clinical Operations Past Accepting new patients
University of Alabama at Birmingham Past Accepting new patients
Endeavor Health Clinical Operations Past Accepting new patients

Locations

3901 Beaubien St
Detroit, MI 48201
Phone (313) 745-5227

Interoperability endpoints

  • FHIR API: https://haiku.northshore.org/Interconnect-FHIR/api/FHIR/R4/

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456790400000",
    "number": "1154480630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 ST. ANTOINE - UHC 5D - #226",
            "address_2": "UNIVERSITY PEDIATRICIANS",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012153",
            "telephone_number": "313-745-4405",
            "fax_number": "313-966-0665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 BEAUBIEN",
            "address_2": "CHILDREN'S HOSPITAL OF MI",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48201",
            "telephone_number": "313-745-4405",
            "fax_number": "313-966-0665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "SIDHARTHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2016-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301109000",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036068889",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "MI",
            "license": "4301109000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "036068889",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4301109000",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.