Individual provider Active NPI

Johnny Tam, RPA-C

  • Physician Assistant
  • New York, NY
National Provider Identifier
1508949934
Registry record updated Apr 9, 2021
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Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
009081 Issued in NY
Practice address
535 E 70TH St.
New York, NY 10021-4823
Phone
(646) 797-8743
Fax
(646) 797-8573
NPI assigned
Oct 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 009081 NY Primary

Addresses

Primary practice location

535 E 70TH St.
New York, NY 10021-4823

Mailing address

535 E 70TH St.
New York, NY 10021-4823
Phone (212) 606-1000

Other identifiers 1

IdentifierTypeStateIssuer
00246075MedicaidNY

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address jtam7414@direct.HSS.edu Direct
FHIR URL https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/ Direct
FHIR URL https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2 Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20170612002718 NY Order and Referring Only - Physician Assistant 6709071038

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
009081NYMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: jtam7414@direct.hss.edu

NPI Registry JSON

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617926400000",
    "number": "1508949934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 E 70TH ST.",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214823",
            "telephone_number": "212-606-1000",
            "fax_number": "646-797-8573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 E 70TH ST.",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214823",
            "telephone_number": "646-797-8743",
            "fax_number": "646-797-8573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAM",
        "first_name": "JOHNNY",
        "name_prefix": "Mr.",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-21",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "009081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00246075",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jtam7414@direct.HSS.edu",
            "affiliation": "N",
            "endpointDescription": "direct messaging address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St.",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "current FHIR URL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St.",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "legacy FHIR URL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St.",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.