Ernesto Tan, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

036049705 Issued in IL

Practice address

300 Read St Ste a
Lockport, IL 60441-3265

Phone

(815) 741-1020

Fax

(815) 741-1064

NPI assigned

Aug 23, 2006

Last updated

Aug 30, 2023By 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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Urology

Education

Other, 1972

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Graham Hospital AssociationGroup PAC ID 2769375021, 124 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Graham Hospital Association Hospital, Canton, IL, CCN 141356
• Graham Hospital Association Hospital, Canton, IL, CCN 140001
• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
• St Mary Medical Center Hospital, Galesburg, IL, CCN 140064

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Graham Hospital Association

  • Critical Access Hospital
  • Canton, IL
  • NPI 1780692087
  Medicare reassignment Care Compare group NPD
• Prime Healthcare Illinois Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Des Plaines, IL
  • NPI 1023837689
  Medicare reassignment NPD
• Ernesto Tan, M.D.S.C.

  • Urology Physician
  • Joliet, IL
  • NPI 1881782126
  NPD (past) Authorized official
• Graham Hospital Association

  dba Knox & Fulton County Wound and Hyperbaric Medicine

  • Internal Medicine Physician
  • Galesburg, IL
  • NPI 1710845854
  NPD
• Graham Hospital Association

  dba Graham Medical Group Farmington

  • Rural Health Clinic/Center
  • Farmington, IL
  • NPI 1841436268
  NPD
• United Shockwave Services, LTD.

  • Ambulatory Surgical Clinic/Center
  • La Grange, IL
  • NPI 1336526219
  NPD
• United Shockwave Services, LTD.

  • Urology Physician
  • Park Ridge, IL
  • NPI 1497132377
  NPD
• United Shockwave Services, LTD.

  • Lithotripsy Clinic/Center
  • Park Ridge, IL
  • NPI 1811944515

  Urology

  NPD
• Associated Urological Specialists

  • Urology Physician
  • Morris, IL
  • NPI 1407998834
  NPD (past)

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

• Graham Hospital Association

  • Critical Access Hospital
  • Canton, IL
  • NPI 1154117521
  Care Compare affiliation
• St Mary Medical Center

  dba OSF Saint Mary Medical Center

  • General Acute Care Hospital
  • Galesburg, IL
  • NPI 1164485363
  Care Compare affiliation

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693353600000",
    "number": "1699882084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10400 SOUTHWEST HWY LOWR LEVEL",
            "city": "CHICAGO RIDGE",
            "state": "IL",
            "postal_code": "604152394",
            "telephone_number": "708-590-8770",
            "fax_number": "708-428-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 READ ST STE A",
            "city": "LOCKPORT",
            "state": "IL",
            "postal_code": "604413265",
            "telephone_number": "815-741-1020",
            "fax_number": "815-741-1064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "ERNESTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036049705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR PTAM",
            "identifier": "DF2482",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE PTAN",
            "identifier": "IL3265",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1467471540",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Taft School District #90
• Tammy Giannetta DDS
• Ingrid Kristine Taylor, DPT
• Telecab, Inc.
• Manali V. Thakore, MS BCBA
• The Legacy Ranch LLC
• The Practice Counseling & Wellness

• Urology Physician in Lockport, IL
• Providers in Lockport, IL by specialty
• Urology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; 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.