Tanner Bo Carlson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

6896 Issued in AZ

Practice address

1100 E Monroe St Ste 101
Globe, AZ 85501-1304

Phone

(928) 425-8200

Fax

(928) 425-8406

NPI assigned

Oct 3, 2017

Last updated

Oct 3, 2017By the provider in NPPES

Sex

Male

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 AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cobre Valley Regional Medical CenterGroup PAC ID 0648181693, 40 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Billet Home Health Inc - Mesa Home health agency, Mesa, AZ, CCN 037828
• Cobre Valley Regional Medical Center Hospital, Globe, AZ, CCN 031314

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Cobre Valley Regional Medical Center

  • Critical Access Hospital
  • Globe, AZ
  • NPI 1871566521
  Medicare reassignment Care Compare group NPD
• Cobre Valley Regional Medical Center

  • Community/Retail Pharmacy
  • Globe, AZ
  • NPI 1639384233
  NPD
• Cobre Valley Regional Medical Center

  dba Cobre Valley Tonto Basin Clinic

  • Rural Health Clinic/Center
  • Tonto Basin, AZ
  • NPI 1144799677
  NPD (past)

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

• Billet Home Health Inc Mesa

  • Home Health Agency
  • Mesa, AZ
  • NPI 1396497889
  Care Compare affiliation
• Cobre Valley Regional Medical Center

  dba Cobre Valley Regional Medical Center Kearny Ambulance

  • Ambulance
  • Kearny, AZ
  • NPI 1245824747

  Hospital

  Care Compare affiliation
• Cobre Valley Regional Medical Center

  • Community/Retail Pharmacy
  • Globe, AZ
  • NPI 1639384233

  Hospital

  Care Compare affiliation
• Cobre Valley Regional Medical Center

  • Critical Access Hospital
  • Globe, AZ
  • NPI 1871566521
  Care Compare affiliation

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

{
    "created_epoch": "1506988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506988800000",
    "number": "1669982740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1641",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855021641",
            "telephone_number": "928-425-8200",
            "fax_number": "928-425-8406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E MONROE ST STE 101",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855011304",
            "telephone_number": "928-425-8200",
            "fax_number": "928-425-8406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "TANNER",
        "middle_name": "BO",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-03",
        "last_updated": "2017-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "6896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Call
• Chad Michael Campbell, PA-C
• Canyonlands Community Health Care (Canyonlands Healthcare Globe)
• Care for Kids of Arizona, LLC (Arizona's Tooth Doctor for Kids-Globe)
• Sherida Carlson, PAC
• Brent Carpeso
• City of Globe Fire Department
• CJ Campbell LLC
• Janet M Cline, DC
• Cobre Valley Community Hospital

• Medical Physician Assistant in Globe, AZ
• Providers in Globe, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.