Individual provider Active NPI

Corinne Tan, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Saint Louis, MO
National Provider Identifier
1770710105
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
2020036060 Issued in MO
Practice address
1465 S Grand Blvd
Saint Louis, MO 63104-1003
Phone
(314) 268-4180
NPI assigned
Jun 11, 2009
Last updated
Mar 22, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X 2020036060 MO
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 2020036060 MO Primary

Addresses

Primary practice location

1465 S Grand Blvd
Saint Louis, MO 63104-1003

Mailing address

1465S. Grand Boulevard
Glennon Hall 5727
Saint Louis, MO 63104
Phone (314) 268-4180

Other practice location 1

545 Barnhill Dr
Emerson Hall 203
Indianapolis, IN 46202-5112
Phone (317) 274-5707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20201209000569 MO Practitioner - Thoracic Surgery 6800033465 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
Saint Louis University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Care GroupGroup PAC ID 0143608372, 929 clinicians

Practice addresses (Care Compare)

10101 Woodfield LN
Saint Louis, MO 63132-2946
Phone (608) 280-4647

1465 S Grand Blvd
Saint Louis, MO 63104-1003
Phone (314) 577-5641

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2020036060MOMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Care Group CurrentSince Jul 1, 2022 Accepting new patients
SSM Health Care Group CurrentSince Jul 1, 2022 Accepting new patients
SSM Medical Group Inc. Past Accepting new patients
SSM Cardinal Glennon Children's Hospital Past Accepting new patients

Locations

10101 Woodfield Ln
Saint Louis, MO 63132
Phone (608) 280-4647

1465 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 268-4070

1465 S Grand Blvd
#5727
Saint Louis, MO 63104

1465 S Grand Blvd
Fl 5
Saint Louis, MO 63104
Phone (314) 577-5334

3635 Vista Ave
Saint Louis, MO 63110
Phone (314) 577-8022

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1770710105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1465S. GRAND BOULEVARD",
            "address_2": "GLENNON HALL 5727",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63104",
            "telephone_number": "314-268-4180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631041003",
            "telephone_number": "314-268-4180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "545 Barnhill Dr",
            "address_2": "Emerson Hall 203",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025112",
            "country_code": "US",
            "telephone_number": "317-274-5707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "CORINNE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-11",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "MO",
            "license": "2020036060",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MO",
            "license": "2020036060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.