NPIMap

Individual provider Active NPI

Ricardo Antonio Tan, MD

  • Allergy Physician
  • Los Angeles, CA
National Provider Identifier
1255353629
Registry record updated Mar 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
A052236 Issued in CA
Practice address
1950 Sawtelle Blvd Ste 138
Los Angeles, CA 90025-7014
Phone
(310) 966-9022
Fax
(310) 966-9042
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X A052236 CA Primary

Addresses

Primary practice location

1950 Sawtelle Blvd Ste 138
Los Angeles, CA 90025-7014

Mailing address

5219 Cedros Ave
Sherman Oaks, CA 91411-4016
Phone (310) 709-2693

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20041019001442 CA Practitioner - Allergy/ImmunologyPractitioner - Internal Medicine 5395706790 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Allergy/ImmunologyAlso: Internal Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1950 Sawtelle Blvd
Suite 138
Los Angeles, CA 90025-7014
Phone (310) 966-9022

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A052236CAMDAllergy Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Houshang Farhadian, MD, Inc Allergy CurrentSince Jul 29, 2010 Accepting new patients
Lancaster Hospital Corporation Past Accepting new patients
Oso Home Care, Inc. Past Accepting new patients
Good Samaritan Hospital, L.P. Past Accepting new patients
Providence Health System - Southern California Past Accepting new patients
Providence Saint John'S Health Center Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
United Hearts Hospice Health Services IncSimi Valley, CA, CCN 921730 Hospice Contracted Managing Employee (100%) Oct 8, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Hospital & facility affiliations 1

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": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490313600000",
    "number": "1255353629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5219 CEDROS AVE",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914114016",
            "telephone_number": "310-709-2693",
            "fax_number": "661-266-3766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 SAWTELLE BLVD STE 138",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900257014",
            "telephone_number": "310-966-9022",
            "fax_number": "310-966-9042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "RICARDO",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2017-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "CA",
            "license": "A052236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.