NPIMap

Individual provider Active NPI

Edwin V Tan, MD

  • Internal Medicine Physician
  • Auburn, ME
National Provider Identifier
1629074240
Registry record updated Aug 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD14191 Issued in ME
Practice address
2 Great Falls PLZ Ste 21
Auburn, ME 04210
Phone
(207) 330-3950
Fax
(207) 330-3955
NPI assigned
Jun 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD14191 ME Primary

Addresses

Primary practice location

2 Great Falls PLZ Ste 21
Auburn, ME 04210

Mailing address

PO Box 7291
Lewiston, ME 04243-7291
Phone (207) 755-3781

Other practice location 1

106 Campus Ave
Lewiston, ME 04240-6019
Phone (207) 755-3383

Other identifiers 1

IdentifierTypeStateIssuer
294700099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20040812001517 ME Practitioner - Internal Medicine 8325011950 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Marys Regional Medical CenterGroup PAC ID 0042107120, 192 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

2 Great Falls PLZ
Suite 21
Auburn, ME 04210-5966
Phone (207) 330-3950

730 Ctr St
Suite 9
Auburn, ME 04210-6316
Phone (207) 783-3450

Hospital & facility affiliations

  • Andwell Health Partners Home health agency, Lewiston, ME, CCN 207019
  • Andwell Health Partners Hospice, Lewiston, ME, CCN 201513
  • St Mary'S Regional Medical Center Hospital, Lewiston, ME, CCN 200034
  • Central Maine Medical Center Hospital, Lewiston, ME, CCN 200024

Merit-based Incentive Payment System (MIPS)

Final score
97.93 of 100Reported as apm
Quality
83.31
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD14191MEMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Regional Medical Center CurrentSince Jul 18, 2011 Accepting new patients
St. Mary'S Regional Medical Center CurrentSince Jul 18, 2011 Accepting new patients
Down East Community Hospital Past Accepting new patients
Woodlands Senior Living of Lewiston, LLC Past Accepting new patients

Locations

106 Campus Ave
Lewiston, ME 04240
Phone (207) 755-3383

93 Campus Ave
Lewiston, ME 04240
Phone (207) 755-3715

Interoperability endpoints

  • Direct secure messaging: etan1156255@direct.bsmhealth.org

Organizations & group practices 4

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 4

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": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533859200000",
    "number": "1629074240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7291",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042437291",
            "telephone_number": "207-755-3781",
            "fax_number": "207-777-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GREAT FALLS PLZ STE 21",
            "city": "AUBURN",
            "state": "ME",
            "postal_code": "04210",
            "telephone_number": "207-330-3950",
            "fax_number": "207-330-3955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 Campus Ave",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ME",
            "postal_code": "042406019",
            "country_code": "US",
            "telephone_number": "207-755-3383",
            "fax_number": "207-755-3285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "EDWIN",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2018-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ME",
            "license": "MD14191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "294700099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Auburn, ME

Sources for this page

Verify at the official NPI Registry.