Timothy R Pangborn, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

G39084 Issued in CA

Practice address

800 E Washington Blvd
Crescent City, CA 95531-8359

Phone

(707) 464-8511

NPI assigned

Jul 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Aug 25, 2017 through Aug 25, 2027

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434585600000",
    "number": "1548286248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 W CEDAR ST",
            "address_2": "4TH FLOOR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325024910",
            "telephone_number": "800-444-7009",
            "fax_number": "818-587-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 E WASHINGTON BLVD",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318359",
            "telephone_number": "707-464-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANGBORN",
        "first_name": "TIMOTHY",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2015-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G39084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G390840",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G390840",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pacific Vision Medical Center
• Marcus T Padilla
• Erica Tiffany Page, MSW, PPSC-SSW
• Karen Ellen Painter
• Raquel Gabriela Pamplona Da Silva
• Leena Park
• Janet Parker
• Cecilia Marie Patton, D.C.
• Darren Travis Patton, AMFT
• Heather J Payne, RN

• Emergency Medicine Physician in Crescent City, CA
• Providers in Crescent City, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.