Individual provider Active NPI

Catherine Tan, M.D.

  • Pediatrics Physician
  • San Bernardino, CA
National Provider Identifier
1598870248
Registry record updated Apr 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
G78137 Issued in CA
Practice address
1454 E 2ND St
San Bernardino, CA 92408-0118
Phone
(909) 382-7146
NPI assigned
Aug 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X G78137 CA Primary

Addresses

Primary practice location

1454 E 2ND St
San Bernardino, CA 92408-0118

Mailing address

1454 E 2ND St
San Bernardino, CA 92408-0118
Phone (909) 382-7146

Other identifiers 1

IdentifierTypeStateIssuer
00G781370MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081222000387 CA Practitioner - Pediatric Medicine 8921160169 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm CurrentSince Feb 14, 2010 Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Feb 14, 2010 Accepting new patients
Faculty Physicians and Surgeons of Llusm Pediatrics Current Accepting new patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Loma Linda University Medical Center Past Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients

Locations

81 Highland Springs Ave
Ste 103
Beaumont, CA 92223
Phone (909) 558-2830

7223 Church St
Ste C1
Highland, CA 92346
Phone (909) 425-3946

25845 Barton Rd
Ste F
Loma Linda, CA 92354
Phone (909) 558-2828

11370 Anderson St
#B100
Loma Linda, CA 92354
Phone (909) 558-2848

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

11441 Heacock St
Ste C
Moreno Valley, CA 92557
Phone (951) 247-5809

11401 Heacock St
Ste 330
Moreno Valley, CA 92557
Phone (951) 247-8697

28078 Baxter Rd
Murrieta, CA 92563
Phone (951) 290-4000

26780 Barton Rd
Redlands, CA 92373
Phone (909) 558-5174

2195 Club Center Dr
Ste A
Sn Bernrdno, CA 92408
Phone (909) 835-1750

Interoperability endpoints

  • Direct secure messaging: ctan2318@direct.llu.edu

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366675200000",
    "number": "1598870248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 E 2ND ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924080118",
            "telephone_number": "909-382-7146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1454 E 2ND ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924080118",
            "telephone_number": "909-382-7146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "CATHERINE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2013-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G78137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G781370",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.