Tatyana Humphreys, M.D.

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

MD047761L Issued in PA

Practice address

306 Gypsy LN
Wynnewood, PA 19096-1103

Phone

(484) 343-8751

Fax

(610) 572-7262

NPI assigned

Jul 21, 2006

Last updated

Sep 29, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

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

Micrographic Dermatologic Surgery (MDS)Also: Dermatology

Education

Perelman School of Med at the University of Pennsylvania, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

John K. Wildemore, MD, LLCGroup PAC ID 5698775104, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

92.44 of 100Reported as group

Quality

100

Promoting interoperability

100

Improvement activities

40

Cost

74.8

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• John K. Wildemore, MD, LLC

  • Dermatology Physician
  • Wayne, PA
  • NPI 1376632257
  Medicare reassignment Care Compare group NPD
• Main Line Dermatology, Inc.

  • Specialist
  • Wayne, PA
  • NPI 1497787246
  Medicare reassignment NPD
• Sylvan Dermatology LLC

  • Dermatology Physician
  • Ardmore, PA
  • NPI 1275151458
  Medicare reassignment NPD
• Main Line Center for Skin Surgery, Inc

  • MOHS-Micrographic Surgery Physician
  • Narberth, PA
  • NPI 1346443496
  Authorized official Same address or phone
• Jefferson University Physicians

  • General Practice Physician
  • Philadelphia, PA
  • NPI 1326093675

  Dermatology

  NPD (past)
• Lynn M. Klein, M.D., L.L.C.

  • Dermatology Physician
  • Wynnewood, PA
  • NPI 1326162637
  NPD (past)
• Pennsylvania Centre for Dermatology, LLC

  • Dermatology Physician
  • Philadelphia, PA
  • NPI 1861501801
  NPD (past)
• Philadelphia Dermatology Associates, PC

  • Dermatology Physician
  • Philadelphia, PA
  • NPI 1861491243
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1184645731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 GYPSY LN",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190961103",
            "telephone_number": "484-343-8751",
            "fax_number": "610-572-7262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 GYPSY LN",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190961103",
            "telephone_number": "484-343-8751",
            "fax_number": "610-572-7262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMPHREYS",
        "first_name": "TATYANA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD047761L",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "PA",
            "license": "MD047761L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016592",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7582706",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Lee Hrin
• Fengling Hu, MD
• Ying Hu
• Zong-Yuan Hu
• Mary Huff
• Omar Hussain, M.D.
• Mohammed Hussein Kamareddine, MD
• Stephanie Ann Hutchison, D.O.
• Sarah Iacona, CRNP
• Jackeline Iacovella, MD

• MOHS-Micrographic Surgery Physician in Wynnewood, PA
• Providers in Wynnewood, PA by specialty
• MOHS-Micrographic Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; 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.