Individual provider Active NPI

Olmedo Alexander Roldan Tesoro, MD

  • Anesthesiology Physician
  • Tacoma, WA
National Provider Identifier
1699766485
Registry record updated Jan 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD00043243 Issued in WA
Practice address
1717 S J St
Tacoma, WA 98405-4933
Phone
(844) 364-2778
Fax
(253) 274-7991
NPI assigned
Nov 2, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD00043243 WA Primary

Addresses

Primary practice location

1717 S J St
Tacoma, WA 98405-4933

Mailing address

1717 S J St
Tacoma, WA 98405-4933
Phone (844) 364-2778

Other identifiers 2

IdentifierTypeStateIssuer
1016611MedicaidWA
0236637OtherWASTATE L&I

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address otesoro12802@fhsce.catholichealth.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20040803000694 WA Practitioner - Anesthesiology 5597736686 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

1717 S J St
Tacoma, WA 98405-4933
Phone (253) 426-6341

Hospital & facility affiliations

  • St Clare Hospital Hospital, Lakewood, WA, CCN 500021
  • St Anthony Hospital Hospital, Gig Harbor, WA, CCN 500151
  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD00043243WAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group Current Accepting new patients
Franciscan Medical Group CurrentSince May 7, 2018 Accepting new patients
Franciscan Medical Group Past Accepting new patients
Fox Medical Center PastSince Jun 27, 2021 Accepting new patients

Locations

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

1313 Broadway
Ste 200
Tacoma, WA 98402
Phone (253) 301-6400

11315 Bridgeport Way SW
Tacoma, WA 98499
Phone (253) 588-1711

1717 S J St
#136
Tacoma, WA 98405
Phone (253) 426-6363

4620 Bridgeport Way W
University Place, WA 98466
Phone (253) 564-0170

Interoperability endpoints

  • Direct secure messaging: otesoro12802@fhsce.catholichealth.net

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 6

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": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610928000000",
    "number": "1699766485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 S J ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054933",
            "telephone_number": "844-364-2778",
            "fax_number": "253-274-7991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S J ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054933",
            "telephone_number": "844-364-2778",
            "fax_number": "253-274-7991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TESORO",
        "first_name": "OLMEDO",
        "middle_name": "ALEXANDER ROLDAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2021-01-18",
        "certification_date": "2021-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD00043243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1016611",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE L&I",
            "identifier": "0236637",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "otesoro12802@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1717 S J St",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984054933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.