NPIMap

Individual provider Active NPI

Thomas B Tan, MD

  • Hematology & Oncology Physician
  • Lake St Louis, MO
National Provider Identifier
1275528382
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
2020008924 Issued in MO
Practice address
400 Medical PLZ Ste 100
Lake St Louis, MO 63367-1493
Phone
(636) 639-8600
NPI assigned
Sep 14, 2005
Last updated
Mar 3, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 2020008924 MO Primary
Hematology & Oncology Physician 207RH0003X 62467 FL
Hematology & Oncology Physician 207RH0003X 17614 AL
Medical Oncology Physician 207RX0202X MD221267 OR
Medical Oncology Physician 207RX0202X H2823 TX

Addresses

Primary practice location

400 Medical PLZ Ste 100
Lake St Louis, MO 63367-1493

Mailing address

4724 N Davis Hwy
Pensacola, FL 32503-2339
Phone (850) 696-4000

Other practice location 1

2717 Michaelangelo Dr Ste 200
Edinburg, TX 78539-1412
Phone (956) 362-2250

Other practice location 2

2610 Uhrmann Rd
Klamath Falls, OR 97601-1123
Phone (541) 274-4171

Other practice location 3

Rapid City Regional Hospital
353 Fairmont Blvd.
Rapid City, SD 57701
Phone (850) 232-1165

Other identifiers 4

IdentifierTypeStateIssuer
110905OtherALAL MEDICAID- WEST FLORIDA OFFICE
109896OtherALAL MEDICAID- FOLEY
371163300MedicaidFL
110883OtherALAL MEDICAID- N DAVIS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, CO, OR, MO4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20191126001902 SD Practitioner - Medical Oncology 7012012677 Reassigns benefits to 1 organization
I20200210000219 CO Practitioner - Internal Medicine 7012012677 Reassigns benefits to 1 organization
I20240909003663 OR Practitioner - Medical Oncology 7012012677 Reassigns benefits to 1 organization
I20250210003469 MO Practitioner - Medical OncologyPractitioner - Hematology/Oncology 7012012677 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Medical OncologyAlso: Hematology/Oncology
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians

Practice addresses (Care Compare)

400 Medical PLZ
Suite 100
Lake St Louis, MO 63367-1493
Phone (636) 639-8600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17614ALMDHematology & Oncology Physician
62467FLMDHematology & Oncology Physician
MD221267ORMDMedical Oncology Physician
H2823TXMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sky Lakes Medical Center Inc CurrentSince Sep 9, 2024 Accepting new patients
Monument Health Rapid City Hospital Inc CurrentSince Sep 11, 2019 Accepting new patients
Monument Health Rapid City Hospital, Inc Current Accepting new patients
Intermountain Medical Group Grand Junction, LLC Internal Medicine CurrentSince Jan 3, 2020 Accepting new patients
SSM Medical Group Inc. CurrentSince Feb 5, 2025 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Jan 3, 2020 Accepting new patients
Monument Health Rapid City Hospital, Inc CurrentSince Sep 11, 2019 Accepting new patients
Sky Lakes Medical Center Inc CurrentSince Sep 9, 2024 Accepting new patients
SSM Medical Group, Inc. Internal Medicine CurrentSince Feb 5, 2025 Accepting new patients
SSM Health Care St. Louis Internal Medicine Past Accepting new patients
St Mary's Hospital and Medical Center, Inc Past Accepting new patients

Locations

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

750 Wellington Ave
Grand Junction, CO 81501
Phone (970) 244-2457

400 Medical Plz
Ste 100
Lake St Louis, MO 63367
Phone (636) 639-8600

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

3555 Sunset Office Dr
Ste C100
Saint Louis, MO 63127
Phone (314) 238-9100

2610 Uhrmann Rd
Klamath Falls, OR 97601
Phone (541) 274-4171

2865 Daggett Ave
Klamath Falls, OR 97601
Phone (541) 833-6221

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

Interoperability endpoints

  • Direct secure messaging: ttan523483@direct-ehr-ssmhc.com

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 6

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": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1275528382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4724 N DAVIS HWY",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032339",
            "telephone_number": "850-696-4000",
            "fax_number": "850-434-2647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MEDICAL PLZ STE 100",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633671493",
            "telephone_number": "636-639-8600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2717 Michaelangelo Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Edinburg",
            "state": "TX",
            "postal_code": "785391412",
            "country_code": "US",
            "telephone_number": "956-362-2250",
            "fax_number": "956-362-2251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2610 Uhrmann Rd",
            "address_purpose": "LOCATION",
            "city": "Klamath Falls",
            "state": "OR",
            "postal_code": "976011123",
            "country_code": "US",
            "telephone_number": "541-274-4171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Rapid City Regional Hospital",
            "address_2": "353 Fairmont Blvd.",
            "address_purpose": "LOCATION",
            "city": "Rapid City",
            "state": "SD",
            "postal_code": "57701",
            "country_code": "US",
            "telephone_number": "850-232-1165",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "THOMAS",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MO",
            "license": "2020008924",
            "primary": true
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "FL",
            "license": "62467",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "AL",
            "license": "17614",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "OR",
            "license": "MD221267",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "TX",
            "license": "H2823",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AL MEDICAID- WEST FLORIDA OFFICE",
            "identifier": "110905",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AL MEDICAID- FOLEY",
            "identifier": "109896",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371163300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AL MEDICAID- N DAVIS",
            "identifier": "110883",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake St Louis, MO

Sources for this page

Verify at the official NPI Registry.