Individual provider Active NPI

Chung Ning Tan, MD

  • Family Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1619357779
Registry record updated Oct 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01077240A Issued in IN
Practice address
7230 Engle Rd
Fort Wayne, IN 46804
Phone
(260) 234-5400
Fax
(260) 234-5410
NPI assigned
Jun 4, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 11018187 IN
Family Medicine Physician 207Q00000X 01077240A IN Primary

Addresses

Primary practice location

7230 Engle Rd
Fort Wayne, IN 46804

Mailing address

1200 W White River Blvd
Provider Enrollment Department
Muncie, IN 47303-4988
Phone (260) 234-5400

Other practice location 1

750 Broadway Ste 350
Fort Wayne, IN 46802-1412
Phone (260) 423-2675

Other practice location 2

3909 New Vision Dr
Fort Wayne, IN 46845-1725
Phone (260) 469-6610

Other identifiers 2

IdentifierTypeStateIssuer
000001176909OtherINANTHEM BCBS
201297950MedicaidIN

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address ctan86818@Direct.Parkviewexchange.com
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/
FHIR URL https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20161017000359 IN Practitioner - Family PracticePractitioner - Emergency Medicine 1052623394 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Parkview Health System IncGroup PAC ID 2163336967, 1,350 clinicians

Practice addresses (Care Compare)

10515 Illinois Rd
Fort Wayne, IN 46814-9182
Phone (260) 266-7400

817 Trail Ridge Rd
Albion, IN 46701-1534
Phone (260) 373-9590

Hospital & facility affiliations

  • Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
  • Parkview Huntington Hospital Hospital, Huntington, IN, CCN 150091
  • Lutheran Hospital of Indiana Hospital, Fort Wayne, IN, CCN 150017
  • Parkview Whitley Hospital Hospital, Columbia City, IN, CCN 150101

Merit-based Incentive Payment System (MIPS)

Final score
83.53 of 100Reported as group
Quality
70
Promoting interoperability
100
Improvement activities
40
Cost
75.11

Merit-based Incentive Payment System (MIPS)

Final score
95.38 of 100Reported as group
Quality
87.23
Promoting interoperability
100
Improvement activities
40
Cost
83.74

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11018187INMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Wabash Hospital, Inc. Current Accepting new patients
Indiana University Health Urgent Care Centers, LLC. CurrentSince Jun 9, 2020 Accepting new patients
Indiana University Health Urgent Care Centers, LLC CurrentSince Jun 9, 2020 Accepting new patients
Indiana University Health Ball Memorial Physicians, Inc. Family Medicine CurrentSince Aug 1, 2018 Accepting new patients
Parkview Health System Inc Family Medicine CurrentSince Aug 3, 2021 Accepting new patients
Indiana University Health Fort Wayne Physicians, LLC Family Medicine CurrentSince Jan 1, 2021 Accepting new patients

Locations

3832 Solutions Ctr
Chicago, IL 60677

817 Trail Ridge Rd
Albion, IN 46701
Phone (260) 373-9590

1381 N Wayne St
Angola, IN 46703
Phone (219) 481-4700

306 E Maumee St
Angola, IN 46703
Phone (260) 667-5335

416 E Maumee St
Angola, IN 46703
Phone (260) 665-2141

1314 E 7th St
Ste 101
Auburn, IN 46706
Phone (260) 920-2794

90 E Garner Rd
Brownsburg, IN 46112
Phone (225) 214-1031

1100 Mercer Ave
Decatur, IN 46733

10215 Auburn Park Dr
Fort Wayne, IN 46825
Phone (260) 490-2229

2200 Randallia Dr
Fort Wayne, IN 46805
Phone (260) 373-4000

7230 Engle Rd
Fort Wayne, IN 46804
Phone (219) 422-9466

3909 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 373-8000

10515 Illinois Rd
Fort Wayne, IN 46814
Phone (260) 266-7400

7230 Engle Rd
Ste 100
Fort Wayne, IN 46804
Phone (317) 620-0232

256 E Pettit Ave
Ste 100
Fort Wayne, IN 46806

9821 Lima Rd
Ste 103
Fort Wayne, IN 46818
Phone (260) 240-5027

996 S State Road 135
Ste P
Greenwood, IN 46143
Phone (317) 893-3888

240 S Jefferson St
Ste B
Huntington, IN 46750
Phone (219) 259-0000

512 Professional Way
Kendallville, IN 46755
Phone (260) 347-8556

207 N Townline Rd
Lagrange, IN 46761
Phone (260) 266-5300

1200 W White River Blvd
Muncie, IN 47303
Phone (765) 254-4009

221 N Celia Ave
Muncie, IN 47303
Phone (765) 747-3141

1104 N Wayne St
North Manchester, IN 46962
Phone (260) 982-2102

8 John Kissinger Dr
Wabash, IN 46992
Phone (260) 563-7421

Interoperability endpoints

  • Direct secure messaging: ctan86818@direct.parkviewexchange.com

Organizations & group practices 7

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665100800000",
    "number": "1619357779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W WHITE RIVER BLVD",
            "address_2": "PROVIDER ENROLLMENT DEPARTMENT",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473034988",
            "telephone_number": "260-234-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7230 ENGLE RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-234-5400",
            "fax_number": "260-234-5410"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 Broadway Ste 350",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468021412",
            "country_code": "US",
            "telephone_number": "260-423-2675",
            "fax_number": "260-422-4326",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3909 New Vision Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468451725",
            "country_code": "US",
            "telephone_number": "260-469-6610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "CHUNG NING",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-04",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "11018187",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01077240A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000001176909",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201297950",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ctan86818@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "3909 New Vision Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451725",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "3909 New Vision Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451725",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3909 New Vision Dr",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468451725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.