Tackson Tam, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G70073 Issued in CA

Practice address

1010 W la Veta Ave Ste 750
Orange, CA 92868-4312

Phone

(714) 361-6600

Fax

(714) 919-8804

NPI assigned

Mar 14, 2006

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

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Merit-based Incentive Payment System (MIPS)

Final score

57.38 of 100Reported as group

Quality

29.61

Promoting interoperability

100

Improvement activities

0

Cost

73.22

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1548239635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 W LA VETA AVE STE 750",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 W LA VETA AVE STE 750",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684312",
            "telephone_number": "714-361-6600",
            "fax_number": "714-919-8804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAM",
        "first_name": "TACKSON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G70073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "1912919804",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE - PROVIDER PTAN",
            "identifier": "110200071",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI - TYPE 2",
            "identifier": "1912919804",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE - GROUP PTAN",
            "identifier": "CG5665",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN - TYPE 2",
            "identifier": "W1514",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ttam1374283@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "845 W La Veta Ave Ste 108",
            "city": "Orange",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928683930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ross Yukio Takesue, PT, DPT
• Wernher Michael Michael O. Talaboc
• Andres Taleisnik, MD
• Julio Taleisnik, MD
• Brent A Talley, DPT
• Delia Tamasan
• Aimee Tamashiro
• Alexis Marrie Tamayo
• Millani Lynn Tamayo
• Ralph Tamayo

• Internal Medicine Physician in Orange, CA
• Providers in Orange, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.