Bruce Lee M. Tanenbaum, MD
Individual provider Active NPI Psychiatry Physician · Cabin John, MD
NPI 1164590147 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1164590147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- D0019680 (MD)
- Practice address
- 7945 Macarthur Blvd
Suite 221
Cabin John, MD 20818-1634 - Phone
- (301) 320-3701
- Fax
- (301) 320-3742
- NPI assigned
- Nov 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 8
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- University of Maryland School of Medicine, 1976
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Grand Itasca Clinic and Hospital
Lakeview Behavioral Health Inc
Practice addresses (Care Compare)
1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 326-3401
516 S Pokegama Ave
Grand Rapids, MN 55744-3800
Phone (218) 327-2001
Hospital & facility affiliations
- Grand Itasca Clinic and Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 92.35 of 100
- Quality
- 88.69
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 76.65
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in DC, MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040527000641 | DC | Practitioner - Psychiatry | 0547241366 | Reassigns benefits to 1 organization |
| I20201023000563 | MN | Practitioner - Psychiatry | 0547241366 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0019680 | MD | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeview Behavioral Health Inc. | Current |
Accepting new patients | |
| Grand Itasca Clinic and Hospital | Current |
Accepting new patients | |
| Family Behavioral Services, LLC | Current |
Accepting new patients | |
| Grand Itasca Clinic and Hospital | Current |
Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients | |
| Washington Assessment & Therapy Services | Past | Accepting new patients | |
| Sheppard Pratt Physicians, P.a. | Psychiatry | Past | Accepting new patients |
Locations
1835 University Blvd E
Ste 316
Hyattsville, MD 20783
Phone (301) 270-3200
1601 Golf Course Rd
Grand Rapids, MN 55744
Phone (218) 326-3401
111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401
516 S Pokegama Ave
Grand Rapids, MN 55744
Phone (218) 327-2001
Interoperability endpoints
- btanenbaum514679@fairview.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | D0019680 | MD | Yes |
Addresses
Primary practice location
7945 Macarthur Blvd
Suite 221
Cabin John, MD 20818-1634
Mailing address
7945 Macarthur Blvd
Suite 221
Cabin John, MD 20818-1634
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| M53652 | Other | MD | CONTROLLED SUBSTANCE |
| D0019680 | Other | MD | BOARD OF PHYSICIANS |
Other providers in Cabin John, MD
- Ethel Doris Sayles
- Rivon Shaneyfelt
- Barry Shapiro
- Reiko Shingu
- Jan Iris Smith
- Anne B. Thompson
- Nina Tracy
- Terra Tuono-Shell
- Katherine Voglmayr
- Wellness Corporate Solutions, LLC
All providers in Cabin John, MD · Psychiatry Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.