Xin Tan, M.D., PH.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

58119 Issued in AZ

Practice address

4540 E Baseline Rd Ste 108
Mesa, AZ 85206-4616

Phone

(480) 892-3880

Fax

(480) 545-4551

NPI assigned

Mar 30, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

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.

• Banner Gateway Medical Center

  • General Acute Care Hospital
  • Gilbert, AZ
  • NPI 1699884858
  NPD (past)
• Gilbert Childrens Medical Group Inc

  • Pediatrics Physician
  • Mesa, AZ
  • NPI 1427211804
  NPD (past)

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579824000000",
    "number": "1609239490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4540 E BASELINE RD STE 108",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064616",
            "telephone_number": "480-892-3880",
            "fax_number": "480-545-4551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4540 E BASELINE RD STE 108",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064616",
            "telephone_number": "480-892-3880",
            "fax_number": "480-545-4551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "XIN",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-30",
        "last_updated": "2020-01-24",
        "certification_date": "2020-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "58119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marvin K. Tam, M.D.
• Tamar K Gottfried MD, PLC
• Michelle Tamer
• McKenna Tammo, PA-C
• Alfonso A Tan, MD
• Nicole Tancredi, MSN, APRN, FNP-C, RN
• Tandem Behavior Health Care
• Varun Tandon, MD
• Tanesha'S Loving in Home Care LLC
• Julie Mee Wah Tang, D.M.D.

• Pediatrics Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Pediatrics Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2020; 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.

Verify at the official NPI Registry.