Individual provider Active NPI

Tu Sang Om, M.D.

  • Family Medicine Physician
  • Carson, CA
National Provider Identifier
1487795282
Registry record updated Apr 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A96486 Issued in CA
Practice address
21501 Avalon Blvd Ste 100
Carson, CA 90745-2210
Phone
(310) 835-6627
NPI assigned
Feb 12, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A96486 CA Primary

Addresses

Primary practice location

21501 Avalon Blvd Ste 100
Carson, CA 90745-2210

Mailing address

2259 W 230TH St
Torrance, CA 90501-5208
Phone (310) 325-3248

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tom196693@oc.providencedirect.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070806000292 CA Practitioner - Family Practice 2668563644 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

Glendale, CA 91202

21501 Avalon Blvd
Suite 100
Carson, CA 90745-2210
Phone (310) 835-6627

Hospital & facility affiliations

  • Providence Little Company of Mary Med Ctr Torrance Hospital, Torrance, CA, CCN 050353
  • Torrance Memorial Medical Center Hospital, Torrance, CA, CCN 050351

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Institute Family Medicine CurrentSince Mar 6, 2013 Accepting new patients
Providence Medical Institute Family Medicine CurrentSince Mar 6, 2013 Accepting new patients

Locations

21501 Avalon Blvd
Ste 100
Carson, CA 90745
Phone (310) 835-6627

2801 Atlantic Ave
Long Beach, CA 90806
Phone (310) 933-2000

2121 Santa Monica Blvd
Santa Monica, CA 90404
Phone (310) 281-2024

2382 Crenshaw Blvd
Ste 5
Torrance, CA 90501
Phone (310) 618-6200

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: tom196693@oc.providencedirect.org

Organizations & group practices 2

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": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1487795282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2259 W 230TH ST",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905015208",
            "telephone_number": "310-325-3248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21501 AVALON BLVD STE 100",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907452210",
            "telephone_number": "310-835-6627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OM",
        "first_name": "TU",
        "middle_name": "SANG",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A96486",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tom196693@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "21501 Avalon Blvd Ste 100",
            "city": "Carson",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907452210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carson, CA

Sources for this page

Verify at the official NPI Registry.