Michael Tannenbaum, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01230 Issued in OR

Practice address

1808 Scenic Dr
Apt 107
Modesto, CA 95355

Phone

(510) 409-8966

NPI assigned

Jun 5, 2007

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

Medicare fee-for-service enrollment

Enrolled in OR, WA2 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 2

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Kaiser Foundation Health Plan of the NorthwestGroup PAC ID 5799688230, 1,805 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  WA

  Medicare reassignment Care Compare group
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1306192455
  NPD
• Kaiser Foundation Health Plan of the Northwest

  • Clinic/Center
  • Hillsboro, OR
  • NPI 1942718622
  NPD
• Manor Care of Salmon Creek Wa, Association

  • Skilled Nursing Facility
  • Vancouver, WA
  • NPI 1609171081
  NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Edmonds, WA
  • NPI 1447484274

  Physician Assistant

  NPD (past)
• Cep America LLC

  • Emergency Medicine Physician
  • Roseburg, OR
  • NPI 1780647719
  NPD (past)
• Mobilmed

  • Health Service Clinic/Center
  • Portland, OR
  • NPI 1639555162
  NPD (past)

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244764800000",
    "number": "1457553885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 SCENIC DR",
            "address_2": "APT 107",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554947",
            "telephone_number": "510-409-8966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 SCENIC DR",
            "address_2": "APT 107",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "95355",
            "telephone_number": "510-409-8966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNENBAUM",
        "first_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-05",
        "last_updated": "2009-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tong-Shuan Alicia Tan
• Vivian L Tan, M.D.
• Xiaohui Tan, MD
• Robert M Tanaka, M.D.
• Tia Tang
• Duncan Tanner
• Garth B Tanner, MD
• Shondell Ramona Tanner, M.S.
• Li Tao, M.D.
• Regina Tapetillo

• Physician Assistant in Modesto, CA
• Providers in Modesto, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2009; 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.