Jonathan David Tatum

Primary specialty

Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X

License

MD19694 Issued in RI

Practice address

111 Plain Street 3Rd Floor Suite 101
Providence, RI 02902-3026

Phone

(401) 444-5504

NPI assigned

Mar 21, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

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

Pediatric MedicineAlso: Endocrinology

Education

Tulane University School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rhode Island HospitalGroup PAC ID 8921900044, 430 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jtatum226031@brownhealth.medalliesdirect.net

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.

• Rhode Island Hospital

  • Pediatrics Physician
  • Providence, RI
  • NPI 1861420333
  Medicare reassignment Care Compare group NPD
• Lifespan Physician Group, Inc.

  • General Practice Physician
  • Providence, RI
  • NPI 1407116643
  Medicare reassignment NPD
• Lifespan Corporation

  • Children's Rehabilitation Hospital
  • Providence, RI
  • NPI 1790221232
  NPD
• Lifespan Physician Group, Inc.

  • Emergency Medicine Physician
  • Providence, RI
  • NPI 1568325678
  NPD
• Rhode Island Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1972768174
  NPD
• Lifespan Physician Group, Inc.

  • Psychiatry Physician
  • Providence, RI
  • NPI 1548506793
  NPD (past)
• Rhode Island Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1588659528
  NPD (past)

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1285138586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST STE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054541",
            "telephone_number": "401-444-6779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 PLAIN STREET 3RD FLOOR SUITE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029023026",
            "telephone_number": "401-444-5504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATUM",
        "first_name": "JONATHAN",
        "middle_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-21",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "RI",
            "license": "MD19694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon Ann Tatalo, MS
• Leslie K. Tatar, NP
• Charlene A Tate, MD
• Hadley Tate, PA-C
• Nina Tatevian, MD PHD
• Patricia A Taubin, LMHC
• Carissa Tavares de Almeida
• Tavares Pediatric Center
• Alexa Nicole Tavares, DC
• Alicia Rae Tavares, LMHC

• Pediatric Endocrinology Physician in Providence, RI
• Providers in Providence, RI by specialty
• Pediatric Endocrinology Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.