Individual provider Active NPI

Jesse William Tan, MD

  • Otolaryngology Physician
  • Long Beach, CA
National Provider Identifier
1285630202
Registry record updated Dec 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A068881 Issued in CA
Practice address
2865 Atlantic Ave
Ste 225
Long Beach, CA 90806-7428
Phone
(562) 988-8818
Fax
(562) 988-8819
NPI assigned
Jun 23, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 27, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X A068881 CA Primary

Addresses

Primary practice location

2865 Atlantic Ave
Ste 225
Long Beach, CA 90806-7428

Mailing address

2865 Atlantic Ave
Ste 225
Long Beach, CA 90806-7428
Phone (562) 988-8818

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
I20041007000745 CA Practitioner - Otolaryngology 5597724120 Receives reassigned benefits from 1 practitioner
Practice locations: Long Beach, CA

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Albany Medical College of Union University, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2865 Atlantic Ave
Suite 225
Long Beach, CA 90806-7428
Phone (562) 988-8818

Hospital & facility affiliations

  • Memorialcare Long Beach Medical Center Hospital, Long Beach, CA, CCN 050485
  • St Mary Medical Center Hospital, Long Beach, CA, CCN 050191
  • Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, CA, CCN 050224
  • Uci Health-Orange Hospital, Orange, CA, CCN 050348

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A068881CAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Long Beach Memorial Medical Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Dignity Health Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Organizations & group practices 3

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 5

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": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293408000000",
    "number": "1285630202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2865 ATLANTIC AVE",
            "address_2": "STE 225",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908067428",
            "telephone_number": "562-988-8818",
            "fax_number": "562-988-8819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2865 ATLANTIC AVE",
            "address_2": "STE 225",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908067428",
            "telephone_number": "562-988-8818",
            "fax_number": "562-988-8819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "JESSE",
        "middle_name": "WILLIAM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2010-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A068881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.