NPIMap

Individual provider Active NPI

Derek Tam

  • Physician Assistant
  • Flushing, NY
National Provider Identifier
1568865665
Registry record updated Oct 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
018003 Issued in NY
Practice address
14202 58TH Rd
Flushing, NY 11355-5309
Phone
(646) 283-9356
NPI assigned
Oct 2, 2014
Last updated
Oct 2, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2014

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 018003 NY Primary

Addresses

Primary practice location

14202 58TH Rd
Flushing, NY 11355-5309

Mailing address

14202 58TH Rd
Flushing, NY 11355-5309
Phone (646) 283-9356

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150702000602 NY Practitioner - Physician Assistant 0143532259 Reassigns benefits to 11 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Excel Urgent Care of Astoria PLLCGroup PAC ID 4981874641, 11 clinicians
Midtown New York Doctors Urgent Care PLLCGroup PAC ID 4981851037, 7 clinicians
Excel Urgent Care of Wantagh PLLCGroup PAC ID 9234364027, 40 clinicians
Excel Urgent Care of NHP PLLCGroup PAC ID 1658517883, 15 clinicians

Practice addresses (Care Compare)

15740 Crossbay Blvd
Howard Beach, NY 11414-2747
Phone (917) 300-6969

205 Lexington Ave
Suite 215
New York, NY 10016-6022
Phone (212) 684-4700

3430 Sunrise Hwy
Wantagh, NY 11793-4069
Phone (516) 900-1600

900 Hillside Ave
New Hyde Park, NY 11040-2522
Phone (516) 519-8400

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
018003NYMDMassage Therapist

Interoperability endpoints

  • Direct secure messaging: excelurgentcareastoria.derektam@129612.advancedmd-direct.com
  • Direct secure messaging: northshoreurgentwantagh.derektam@125721.advancedmd-direct.com

Organizations & group practices 11

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": "1412208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412208000000",
    "number": "1568865665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14202 58TH RD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555309",
            "telephone_number": "646-283-9356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14202 58TH RD",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555309",
            "telephone_number": "646-283-9356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAM",
        "first_name": "DEREK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-02",
        "last_updated": "2014-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "018003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.