NPIMap

Individual provider Active NPI

Frederick S Tan, MD

  • Nephrology Physician
  • Bryan, TX
National Provider Identifier
1689698615
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
K8511 Issued in TX
Practice address
2801 E 29TH St
Ste 117
Bryan, TX 77802-2618
Phone
(979) 774-3960
Fax
(979) 774-4506
NPI assigned
Jul 26, 2006
Last updated
Feb 2, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X K8511 TX Primary

Addresses

Primary practice location

2801 E 29TH St
Ste 117
Bryan, TX 77802-2618

Mailing address

2801 E 29TH St
Ste 117
Bryan, TX 77802-2618
Phone (979) 774-3960

Other identifiers 2

IdentifierTypeStateIssuer
0017GCOtherBLUE CROSS BLUE SHILED
390007453OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20110331000337 TX Practitioner - Nephrology 6406941830 Practice locations: Bryan, TX

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2801 E 29TH St
Suite 117
Bryan, TX 77802-2619
Phone (979) 774-3960

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
K8511TXMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Frederick S Tan MD Nephrology PastSince Feb 5, 2001 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: ftan047@yourcarecommunity.org

Organizations & group practices 1

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.

Hospital & facility affiliations 11

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328140800000",
    "number": "1689698615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 E 29TH ST",
            "address_2": "STE 117",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022618",
            "telephone_number": "979-774-3960",
            "fax_number": "979-774-4506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 E 29TH ST",
            "address_2": "STE 117",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022618",
            "telephone_number": "979-774-3960",
            "fax_number": "979-774-4506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "FREDERICK",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2012-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "K8511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHILED",
            "identifier": "0017GC",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "390007453",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

Verify at the official NPI Registry.