NPIMap

Individual provider Active NPI

Kelly J Tucker, M.D.

  • Cardiovascular Disease Physician
  • Orange, CA
National Provider Identifier
1356372643
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
G64833 Issued in CA
Practice address
1140 W. la Veta Ave
Suite # 640
Orange, CA 92868-4228
Phone
(714) 564-3300
Fax
(714) 564-3318
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X G64833 CA Primary

Addresses

Primary practice location

1140 W. la Veta Ave
Suite # 640
Orange, CA 92868-4228

Mailing address

1140 W. la Veta Ave
Suite # 640
Orange, CA 92868-4228
Phone (714) 564-3300

Other identifiers 2

IdentifierTypeStateIssuer
G64833OtherCAMEDICAL LICENSE
GR0064090MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040830000918 CA Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology) 2567362692 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)
Education
Uniformed Services Uhs Fe Hebert School of Med, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1140 W la Veta Ave
Suite 615
Orange, CA 92868-4239
Phone (714) 564-3300

1140 W la Veta Ave
Suite 640
Orange, CA 92868-4228
Phone 71456433001157

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.28 of 100Reported as individual
Quality
70.52
Promoting interoperability
99
Improvement activities
40
Cost
54.16

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Orange County Heart Institute and Research Center a Medical Group Cardiovascular Disease CurrentSince Sep 1, 1994 Accepting new patients
Orange County Global Medical Center, Inc Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients
Tyson C. Cobb, M.D., Inc PastSince Oct 13, 2008 Accepting new patients

Locations

4050 Barranca Pkwy
Ste 110
Irvine, CA 92604
Phone (714) 771-7994

1140 W La Veta Ave
Ste 640
Orange, CA 92868
Phone (714) 543-6054

1140 W La Veta Ave
Orange, CA 92868
Phone (714) 744-8724

1100 W Stewart Dr
Orange, CA 92868
Phone (714) 532-8620

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1356372643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 W. LA VETA AVE",
            "address_2": "SUITE # 640",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684228",
            "telephone_number": "714-564-3300",
            "fax_number": "714-564-3318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 W. LA VETA AVE",
            "address_2": "SUITE # 640",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684228",
            "telephone_number": "714-564-3300",
            "fax_number": "714-564-3318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2023-03-07",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "G64833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "G64833",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0064090",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.