NPIMap

Individual provider Active NPI

Maria Nelisa N Tan, M.D.

  • Pediatrics Physician
  • Red Bluff, CA
National Provider Identifier
1457549107
Registry record updated Nov 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A101565 Issued in CA
Practice address
2450 Sister Mary Columba Dr
Red Bluff, CA 96080-4356
Phone
(530) 527-0414
Fax
(530) 528-4423
NPI assigned
Oct 9, 2007
Last updated
Nov 2, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A101565 CA Primary

Addresses

Primary practice location

2450 Sister Mary Columba Dr
Red Bluff, CA 96080-4356

Mailing address

2450 Sister Mary Columba Dr
Red Bluff, CA 96080-4356
Phone (530) 527-0414

Other identifiers 4

IdentifierTypeStateIssuer
LAB18474GMedicaidCA
GR0089250MedicaidCA
RHM53955FMedicaidCA
LAB18474FMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A101565CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alta Bates Summit Medical Center Past Accepting new patients
Catholic Healthcare West Past Accepting new patients
Sacramento Valley Pediatrics Medical Group Inc Past Accepting new patients
Hill Physicians Medical Group - PPO Program Past Accepting new patients
Sutter Valley Hospitals Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mtan120768@hpmg.direct-ci.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193961600000",
    "number": "1457549107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 SISTER MARY COLUMBA DR",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960804356",
            "telephone_number": "530-527-0414",
            "fax_number": "530-528-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 SISTER MARY COLUMBA DR",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960804356",
            "telephone_number": "530-527-0414",
            "fax_number": "530-528-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "MARIA NELISA",
        "middle_name": "N",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-09",
        "last_updated": "2007-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A101565",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB18474G",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0089250",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53955F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB18474F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Bluff, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.