Tanner Bo Carlson, PA-C
Individual provider Active NPI Medical Physician Assistant · Globe, AZ
NPI 1669982740 · NPPES record last updated Oct 3, 2017
Key facts
- NPI
- 1669982740
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 6896 (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
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cobre Valley Regional Medical Center
Practice addresses (Care Compare)
100 S Tilbury Dr
Kearny, AZ 85137-1218
Phone (520) 363-5573
1134 W US Hwy 60
Superior, AZ 85173-3400
Phone (520) 689-2423
186 E Stephens Way
Tonto Basin, AZ 85553-0239
Phone (928) 479-2871
5880 S Hospital Dr
Globe, AZ 85501-9447
Phone (928) 425-3247
5990 S Hospital Dr
Globe, AZ 85501-9462
Phone (928) 425-8151
5994 S Hospital Dr
Globe, AZ 85501-9462
Phone (928) 425-7108
Hospital & facility affiliations
- Billet Home Health Inc - Mesa
- Cobre Valley Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171214003222 | AZ | Practitioner - Physician Assistant | 7618235961 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6896 | AZ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cobre Valley Regional Medical Center | Current |
Accepting new patients | |
| Cobre Valley Regional Medical Center | Current |
Accepting new patients | |
| Cobre Valley Regional Medical Center | Past | Accepting new patients |
Locations
5990 S Hospital Dr
Globe, AZ 85501
Phone (520) 402-9319
5994 S Hospital Dr
Globe, AZ 85501
Phone (928) 425-7108
5880 S Hospital Dr
Globe, AZ 85501
Phone (928) 402-1217
1134 W US Highway 60
Superior, AZ 85173
Phone (520) 689-2423
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 6896 | AZ | Yes |
Addresses
Primary practice location
1100 E Monroe St Ste 101
Globe, AZ 85501-1304
Mailing address
PO Box 1641
Globe, AZ 85502-1641
Phone (928) 425-8200
Other providers in Globe, AZ
- Jordan Call
- Chad Michael Campbell
- Canyonlands Community Health Care
- Care for Kids of Arizona, LLC
- Sherida Carlson
- Brent Carpeso
- City of Globe Fire Department
- CJ Campbell LLC
- Janet M Cline
- Cobre Valley Community Hospital
All providers in Globe, AZ · Medical Physician Assistant in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.