Active NPI
Raymundo T Tan, M.D.
- Diagnostic Radiology Physician
- Jamestown, ND
National Provider Identifier
1700869229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 4669
- Practice address
- 419 5TH St NE
Jamestown, ND 58401-3300 - Phone
- (701) 252-1050
- Fax
- (701) 952-3265
- NPI assigned
- Nov 29, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 4669 | ND | Primary |
Addresses
Primary practice location
419 5TH St NE
Jamestown, ND 58401-3300
Mailing address
419 5TH St NE
Jamestown, ND 58401-3300
Phone (701) 252-1050
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18514 | Medicaid | ND | |
| 01008891 | Other | PREFERRED ONE | |
| 16-11656 | Other | MEDICA | |
| 7207820 | Medicaid | SD | |
| 47607 | Other | HEALTHPARTNERS | |
| 13243 | Other | ND | BLUE SHIELD |
| 46031641458401C003 | Other | TRICARE | |
| 719609 | Other | AMERICA'S PPO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4669 | ND | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133222400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202256000000",
"number": "1700869229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "419 5TH ST NE",
"city": "JAMESTOWN",
"state": "ND",
"postal_code": "584013300",
"telephone_number": "701-252-1050",
"fax_number": "701-952-3265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "419 5TH ST NE",
"city": "JAMESTOWN",
"state": "ND",
"postal_code": "584013300",
"telephone_number": "701-252-1050",
"fax_number": "701-952-3265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAN",
"first_name": "RAYMUNDO",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-29",
"last_updated": "2008-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "ND",
"license": "4669",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "18514",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "01008891",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "16-11656",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7207820",
"state": "SD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "47607",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "13243",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "46031641458401C003",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO",
"identifier": "719609",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamestown, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.