Cheryl Ann Tanasovich, M.D.

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

G53455 Issued in CA

Practice address

1300 S Eliseo Dr
Suite 207
Greenbrae, CA 94904-2023

Phone

(415) 925-0550

Fax

(415) 925-9062

NPI assigned

Jul 8, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Greenbrae Dermatology, a Medical Corporation

  • Dermatology Physician
  • Greenbrae, CA
  • NPI 1174898654

  Procedural Dermatology

  Medicare reassignment NPD

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184716800000",
    "number": "1215960844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 S ELISEO DR",
            "address_2": "SUITE 207",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042023",
            "telephone_number": "415-925-0550",
            "fax_number": "415-925-9062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S ELISEO DR",
            "address_2": "SUITE 207",
            "city": "GREENBRAE",
            "state": "CA",
            "postal_code": "949042023",
            "telephone_number": "415-925-0550",
            "fax_number": "415-925-9062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANASOVICH",
        "first_name": "CHERYL",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "G53455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL PROVIDER NUMBER",
            "identifier": "00G534551",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE PROVIDER NUMBER",
            "identifier": "931041613",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "0004133440",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROV #",
            "identifier": "00G534550",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PROV #",
            "identifier": "070003525",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sima Tei

• Procedural Dermatology Physician in Greenbrae, CA
• Providers in Greenbrae, CA by specialty
• Procedural Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.