Individual provider Active NPI

Linda Tai, PA-C

  • Surgical Physician Assistant
  • Upland, CA
National Provider Identifier
1386095339
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
57036 Issued in CA
Practice address
901 San Bernardino Rd Ste 102
Upland, CA 91786-4988
Phone
(909) 579-6721
NPI assigned
Jun 30, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2016016697 MO
Surgical Physician Assistant 363AS0400X 3820 TN
Surgical Physician Assistant 363AS0400X 57036 CA Primary

Addresses

Primary practice location

901 San Bernardino Rd Ste 102
Upland, CA 91786-4988

Mailing address

901 San Bernardino Rd Ste 102
Upland, CA 91786-4988
Phone (909) 579-6721

Other practice location 1

946 E Reed St
Hayti, MO 63851-1243
Phone (909) 632-8630

Other practice location 2

877 Jefferson Ave
Memphis, TN 38103-2807
Phone (901) 545-7509

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, TN, CA3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20160908000920 MO Practitioner - Physician Assistant 8921390659
I20190820003851 TN Practitioner - Physician Assistant 8921390659 Reassigns benefits to 1 organization
I20200601001610 CA Practitioner - Physician Assistant 8921390659 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Synergy CT Surgery PartnershipGroup PAC ID 5698939957, 19 clinicians

Practice addresses (Care Compare)

901 San Bernardino Rd
Suite 102
Upland, CA 91786-4988
Phone (909) 579-6721

999 San Bernardino Rd
Upland, CA 91786-4920
Phone (909) 579-6721

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2016016697MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Regional One Physicians Inc Physician Assistant CurrentSince Aug 1, 2019 Accepting new patients
Pacific Professional Surgical Group Inc Past Accepting new patients

Locations

6215 Humphreys Blvd
Ste 201
Memphis, TN 38120
Phone (901) 866-8085

877 Jefferson Ave
Memphis, TN 38103
Phone (901) 448-5893

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: linda.tai.p1@direct.pacificpulm.nextgenshare.com

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 and National Provider Directory roles.

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": "1467244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1386095339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 SAN BERNARDINO RD STE 102",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864988",
            "telephone_number": "909-579-6721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 SAN BERNARDINO RD STE 102",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864988",
            "telephone_number": "909-579-6721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "946 E Reed St",
            "address_purpose": "LOCATION",
            "city": "Hayti",
            "state": "MO",
            "postal_code": "638511243",
            "country_code": "US",
            "telephone_number": "909-632-8630",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "877 Jefferson Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381032807",
            "country_code": "US",
            "telephone_number": "901-545-7509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAI",
        "first_name": "LINDA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-30",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2016016697",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "3820",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "57036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.