Individual provider Active NPI

Edward Tagge, MD

  • Pediatric Surgery Physician
  • Loma Linda, CA
National Provider Identifier
1255446100
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
G88002 Issued in CA
Practice address
11370 Anderson St
Suite 2100
Loma Linda, CA 92354-3450
Phone
(909) 558-2282
Fax
(909) 558-2125
NPI assigned
Aug 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X G88002 CA Primary
Surgery Physician 208600000X G88002 CA
Surgical Critical Care Physician 2086S0102X G88002 CA
Pediatric Surgery Physician 2086S0120X 15516 SC

Addresses

Primary practice location

11370 Anderson St
Suite 2100
Loma Linda, CA 92354-3450

Mailing address

11175 Campus St
CP-21111
Loma Linda, CA 92354
Phone (909) 558-4619

Other identifiers 1

IdentifierTypeStateIssuer
155165MedicaidSC

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20071029000202 CA Practitioner - General SurgeryPractitioner - Pediatric MedicinePractitioner - Critical Care (Intensivists)Practitioner - Other (Physician) 6406893908 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G88002CAMDSurgical Critical Care Physician
15516SCMDPediatric Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Jul 1, 2014 Accepting new patients
Faculty Physicians and Surgeons of Llusm Surgery Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Loma Linda University Children'S Hospital Past Accepting new patients
Faculty Physicians and Surgeons of Llusm Surgery Past Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Faculty Physicians and Surgeons of Llusm Surgery Past Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients

Locations

11370 Anderson St
Ste 1800
Loma Linda, CA 92354
Phone (909) 558-2154

11370 Anderson St
Ste 2100
Loma Linda, CA 92354
Phone (909) 558-2824

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

25455 Barton Rd
Ste 108A
Loma Linda, CA 92354
Phone (909) 558-1617

11234 Anderson St
Loma Linda, CA 92350
Phone (909) 558-3016

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

26520 Cactus Ave
Ste 2021
Moreno Valley, CA 92555
Phone (951) 486-5700

Interoperability endpoints

  • Direct secure messaging: etagge11535@direct.llu.edu

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1255446100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11175 CAMPUS ST",
            "address_2": "CP-21111",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "92354",
            "telephone_number": "909-558-4619",
            "fax_number": "909-558-7978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11370 ANDERSON ST",
            "address_2": "SUITE 2100",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543450",
            "telephone_number": "909-558-2282",
            "fax_number": "909-558-2125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAGGE",
        "first_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "CA",
            "license": "G88002",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "G88002",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "CA",
            "license": "G88002",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "SC",
            "license": "15516",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155165",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.