NPIMap

Individual provider Active NPI

Carol Ann C Tan, MD

  • Internal Medicine Physician
  • Coralville, IA
National Provider Identifier
1356455398
Registry record updated Dec 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
40223 Issued in IA
Practice address
2769 Heartland Dr
Suite 205
Coralville, IA 52241-2732
Phone
(319) 887-2900
Fax
(319) 339-3858
NPI assigned
Aug 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036095755 IL
Internal Medicine Physician 207R00000X 40223 IA Primary

Addresses

Primary practice location

2769 Heartland Dr
Suite 205
Coralville, IA 52241-2732

Mailing address

PO Box 2027
Iowa City, IA 52244-2027
Phone (319) 339-3855

Other identifiers 2

IdentifierTypeStateIssuer
036095755MedicaidIL
P00096917OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20120514000378 IA Practitioner - Family PracticePractitioner - Internal Medicine 0840184818 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Progressive Rehabilitation Associates LLCGroup PAC ID 2961443072, 275 clinicians
Mercy Physician Associates IncGroup PAC ID 1355242496, 103 clinicians

Practice addresses (Care Compare)

1130 S Scott Blvd
Iowa City, IA 52240-2909
Phone (319) 354-2429

1790 Blairs Ferry Rd
Hiawatha, IA 52233-2033
Phone (319) 378-8362

777 76TH Ave Dr SW
Cedar Rapids, IA 52404-7006

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40223IAMDInternal Medicine Physician
036095755ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Physician Associates, Inc Current Accepting new patients
Mercy Physician Associates, Inc CurrentSince Jun 9, 2019 Accepting new patients
Mercy Care Management, Inc CurrentSince Jun 9, 2019 Accepting new patients
Mercy Physician Associates Inc CurrentSince Jun 9, 2019 Accepting new patients
Mercy Care Management, Inc CurrentSince Jun 9, 2019 Accepting new patients
Mercy Physician Associates, Inc Past Accepting new patients

Locations

5264 Council St NE
Ste 100
Cedar Rapids, IA 52402
Phone (319) 221-8444

777 76th Avenue Dr SW
#100
Cedar Rapids, IA 52404
Phone (319) 558-0350

1790 Blairs Ferry Rd
Hiawatha, IA 52233
Phone (319) 378-8362

300 W May St
Marengo, IA 52301
Phone (319) 462-8011

Organizations & group practices 7

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 2

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": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482364800000",
    "number": "1356455398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2027",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522442027",
            "telephone_number": "319-339-3855",
            "fax_number": "319-358-2791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2769 HEARTLAND DR",
            "address_2": "SUITE 205",
            "city": "CORALVILLE",
            "state": "IA",
            "postal_code": "522412732",
            "telephone_number": "319-887-2900",
            "fax_number": "319-339-3858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "CAROL ANN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-18",
        "last_updated": "2016-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036095755",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "40223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036095755",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00096917",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coralville, IA

Sources for this page

Verify at the official NPI Registry.