Individual provider Active NPI

Peter Tan, PA-C

  • Physician Assistant
  • Federal Way, WA
National Provider Identifier
1184113763
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA60865343 Issued in WA
Practice address
34612 6TH Ave S Ste 300
Federal Way, WA 98003-8723
Phone
(253) 838-8552
Fax
(253) 874-6089
NPI assigned
May 9, 2018
Last updated
May 1, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA60865343 WA Primary

Addresses

Primary practice location

34612 6TH Ave S Ste 300
Federal Way, WA 98003-8723

Mailing address

34612 6TH Ave S Ste 300
Federal Way, WA 98003-8723
Phone (253) 838-8552

Other identifiers 1

IdentifierTypeStateIssuer
2114182MedicaidWA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address ptan317450@fhsce.catholichealth.net
Direct Messaging Address ptan317450@fhsce.catholichealth.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190122001686 WA Practitioner - Physician Assistant 9830436310 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

1812 S J St
Suite 120
Tacoma, WA 98405-4965
Phone (253) 428-2200

34503 9TH Ave S
Federal Way, WA 98003-8726

34515 9TH Ave S
Federal Way, WA 98003-6761
Phone (253) 944-7977

34612 6TH Ave S
Suite 300
Federal Way, WA 98003-8723
Phone (253) 838-8552

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group CurrentSince Nov 14, 2018 Accepting new patients
Franciscan Medical Group Physician Assistant Past Accepting new patients

Locations

34503 9th Ave S
Ste 130
Federal Way, WA 98003
Phone (253) 835-5340

34612 6th Ave S
Ste 300
Federal Way, WA 98003
Phone (253) 838-8552

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

Interoperability endpoints

  • Direct secure messaging: ptan317450@fhsce.catholichealth.net

Organizations & group practices 3

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 3

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": "1525824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1184113763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34612 6TH AVE S STE 300",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038723",
            "telephone_number": "253-838-8552",
            "fax_number": "253-874-6089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34612 6TH AVE S STE 300",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038723",
            "telephone_number": "253-838-8552",
            "fax_number": "253-874-6089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "PETER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-09",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60865343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2114182",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ptan317450@fhsce.catholichealth.net",
            "affiliation": "N",
            "address_1": "34612 6th Ave S Ste 300",
            "city": "Federal Way",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980038723",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ptan317450@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "34612 6th Ave S Ste 300",
            "city": "Federal Way",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980038723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.