Gubert Lee Tan, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

35074660 Issued in OH

Practice address

222 Marion Ave
Mansfield, OH 44903-2138

Phone

(419) 526-1964

Fax

(419) 526-0012

NPI assigned

Oct 3, 2005

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH

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

NeurologyAlso: Sleep Medicine

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ohiohealth CorporationGroup PAC ID 6305758426, 2,295 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ohiohealth Mansfield Hospital Hospital, Mansfield, OH, CCN 360118
• University Hospitals Samaritan Medical Center Hospital, Ashland, OH, CCN 360002
• Riverside Methodist Hospital Hospital, Columbus, OH, CCN 360006

Merit-based Incentive Payment System (MIPS)

Final score

80.04 of 100Reported as group

Quality

58.67

Promoting interoperability

98

Improvement activities

40

Cost

76.46

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Ohiohealth Corporation

  dba OhioHealth Physician Group, Inc

  • Family Medicine Physician
  • Columbus, OH
  • NPI 1578545273
  Medicare reassignment Care Compare group NPD
• Galion Community Hospital

  dba GCH Health Services

  • Critical Access Hospital
  • Galion, OH
  • NPI 1215907522
  Medicare reassignment NPD
• Galion Community Hospital

  dba Avita Crestline Pharmacy

  • Pharmacy
  • Crestline, OH
  • NPI 1346061256
  NPD
• Ohiohealth Corporation

  dba OhioHealth Physician Group Inc

  • Anesthesiology Physician
  • Columbus, OH
  • NPI 1407292105
  NPD
• Refuge Counseling, LLC

  • Mental Health Counselor
  • Ashland, OH
  • NPI 1508463597
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Medcentral Health System

  • General Acute Care Hospital
  • Mansfield, OH
  • NPI 1790837235
  Care Compare affiliation
• Medcentral Health System

  dba Mansfield Laboratory Services

  • Clinical Medical Laboratory
  • Mansfield, OH
  • NPI 1962888016

  Hospital

  Care Compare affiliation
• Ohiohealth Corporation

  dba Riverside Methodist Hospital

  • General Acute Care Hospital
  • Columbus, OH
  • NPI 1467484972
  Care Compare affiliation
• Ohiohealth Corporation

  dba OhioHealth Laboratory Systems

  • Clinical Medical Laboratory
  • Columbus, OH
  • NPI 1710916945

  Hospital

  Care Compare affiliation
• Samaritan Regional Health System

  dba University Hospitals Samaritan Medical Center

  • General Acute Care Hospital
  • Ashland, OH
  • NPI 1902882939
  Care Compare affiliation

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1285621490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 FRANTZ RD",
            "address_2": "STE 250",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430164144",
            "telephone_number": "614-544-6155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 MARION AVE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449032138",
            "telephone_number": "419-526-1964",
            "fax_number": "419-526-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "GUBERT",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "IL",
            "license": "036088453",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OH",
            "license": "35074660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2072813",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gtan122140@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "OhioHealth Physician Group",
            "address_1": "335 Glessner Ave",
            "address_2": "MOB 2nd Fl",
            "city": "Mansfield",
            "state": "OH",
            "country_code": "US",
            "postal_code": "449032269",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Clarissa Tackett
• Lorrie Lee Tackett
• Margaret Tackett, LSW
• Taej Residential Care, LLC (Diamond View RCF)
• Taking Root Farms
• Montana Tanner
• Sierrah Taska
• Geron Tate
• John Benjamin David Tatum, DD PHD
• Sherrie Lynn Taulbee, BSN,RN

• Neurology Physician in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Neurology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.