Jonathan Ethan Tannebaum, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

275818 Issued in NY

Practice address

251 N 4TH St
Oakland, MD 21550-1375

Phone

(301) 533-4000

Fax

(301) 895-8751

NPI assigned

Jul 19, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY, MD2 enrollments

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 2

Specialty

General Surgery

Education

Jefferson Medical College of Thomas Jefferson University, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Specialty Physicians of Garrett County, LLCGroup PAC ID 5698082436, 86 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Garrett Regional Medical Center Hospital, Oakland, MD, CCN 210017
• West Virginia University Hospitals, Inc Hospital, Morgantown, WV, CCN 510001

Merit-based Incentive Payment System (MIPS)

Final score

95.34 of 100Reported as apm

Quality

79.86

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jtannebaum221492@direct.wvuhsdirect.com

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.

• Specialty Physicians of Garrett County, LLC

  • Obstetrics & Gynecology Physician
  • Oakland, MD
  • NPI 1265819866
  Medicare reassignment Care Compare group NPD
• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152

  Surgery

  Medicare reassignment NPD
• Olean General Hospital

  • General Practice Physician
  • Bradford, PA
  • NPI 1649296781

  NY, Surgery

  Medicare reassignment NPD
• Specialty Physicians of Garrett County, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Oakland, MD
  • NPI 1871065813
  NPD
• Specialty Physicians of Garrett County, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Grantsville, MD
  • NPI 1881361442
  NPD
• Montefiore Medical Center

  • Community/Retail Pharmacy
  • Bronx, NY
  • NPI 1194183715
  NPD
• Olean General Hospital

  • General Practice Physician
  • Olean, NY
  • NPI 1033499017
  NPD

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

• GRMC, Inc.

  • General Acute Care Hospital
  • Oakland, MD
  • NPI 1598417412
  Care Compare affiliation
• West Virginia University Hospitals, Inc

  • General Acute Care Hospital
  • Morgantown, WV
  • NPI 1841271459
  Care Compare affiliation

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

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629072000000",
    "number": "1285922724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 NIAGARA FALLS BLVD STE 208",
            "city": "NORTH TONAWANDA",
            "state": "NY",
            "postal_code": "141202019",
            "telephone_number": "716-692-3302",
            "fax_number": "716-692-4342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 N 4TH ST",
            "city": "OAKLAND",
            "state": "MD",
            "postal_code": "215501375",
            "telephone_number": "301-533-4000",
            "fax_number": "301-895-8751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNEBAUM",
        "first_name": "JONATHAN",
        "middle_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-19",
        "last_updated": "2021-08-16",
        "certification_date": "2021-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "275818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAR PTAN",
            "identifier": "1H0698",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "996022880",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lois G Swartzentruber, LGSW
• Samantha Marie Swift
• Tabou Psychiatry & Mental Health LLC
• Talk37 LLC
• Elias John Tancin, LGSW
• Sabrina Cassandra Tasker, LCSW-C
• Laura Taylor, MCP, LGPC
• Kendra Lea Thayer
• The Cottage, Mental Health Services LLC
• The Garrett County Sleep Center

• Surgery Physician in Oakland, MD
• Providers in Oakland, MD by specialty
• Surgery Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2021; 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.