Active NPI
Alma Flora Tatum, MD
- Pediatrics Physician
- Red Lake, MN
National Provider Identifier
1558525022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 12540
- Practice address
- 24760 Hospital Dr
Red Lake, MN 56671 - Phone
- (218) 679-3912
- NPI assigned
- Jul 14, 2008
- Last updated
- Aug 7, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 12540 | PR | Primary |
Addresses
Primary practice location
24760 Hospital Dr
Red Lake, MN 56671
Mailing address
PO Box 3144
Bemidji, MN 56619-3144
Phone (787) 426-0682
Other practice location 1
1486 Ave F D Roosevelt Apt 914
San Juan, PR 00920-2740
Phone (787) 426-0682
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12540 | PR | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PHS Indian Hospital | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533600000000",
"number": "1558525022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3144",
"city": "BEMIDJI",
"state": "MN",
"postal_code": "566193144",
"telephone_number": "787-426-0682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24760 HOSPITAL DR",
"city": "RED LAKE",
"state": "MN",
"postal_code": "56671",
"telephone_number": "218-679-3912"
}
],
"practiceLocations": [
{
"address_1": "1486 Ave F D Roosevelt Apt 914",
"address_purpose": "LOCATION",
"city": "San Juan",
"state": "PR",
"postal_code": "009202740",
"country_code": "US",
"telephone_number": "787-426-0682",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TATUM",
"first_name": "ALMA",
"middle_name": "FLORA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-14",
"last_updated": "2018-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PR",
"license": "12540",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Red Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2018; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.