NPIMap

Individual provider Active NPI

Jeffrey C Tan

  • Family Medicine Physician
  • Henderson, NV
National Provider Identifier
1770794216
Registry record updated Nov 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
16847 Issued in NV
Practice address
2845 Siena Heights Dr
Henderson, NV 89052-4153
Phone
(702) 617-7227
NPI assigned
May 25, 2007
Last updated
Nov 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD60158622 WA
Family Medicine Physician 207Q00000X 16847 NV Primary

Addresses

Primary practice location

2845 Siena Heights Dr
Henderson, NV 89052-4153

Mailing address

PO Box 35380
Las Vegas, NV 89133-5380

Other identifiers 4

IdentifierTypeStateIssuer
2008990MedicaidWA
1770794216OtherNVSMA MEDICAID
09962MedicaidLA
V50547OtherNVSMA MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20170316001690 NV Practitioner - Family Practice 4082808951 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Optum Medical Group II Rhodes P CGroup PAC ID 4981687779, 296 clinicians

Practice addresses (Care Compare)

2845 Siena Heights Dr
Henderson, NV 89052-4153
Phone (702) 579-3253

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16847NVMDPharmacist
MD60158622WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Medical Associates, Inc CurrentSince Feb 6, 2017 Accepting new patients
Optum Medical Group Rhodes P C Current Accepting new patients
Optum Medical Group II Rhodes P C CurrentSince Jun 3, 2019 Accepting new patients
Henderson Hospital Past Accepting new patients
Desert View Regional Medical Center Holdings, LLC Past Accepting new patients
Desert Springs Hospital Past Accepting new patients
Peninsula Community Health Services Family Medicine Past Accepting new patients
Spring Valley Medical Center Past Accepting new patients
Dignity Health Past Accepting new patients
Southern Hills Medical Center, LLC Past Accepting new patients
De Craig Ranch, LLC Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients
Dignity Health Past Accepting new patients
Spring Valley Medical Center Past Accepting new patients
De Craig Ranch, LLC Past Accepting new patients
North Vista Hospital LLC Past Accepting new patients
Sunrise Hospital and Medical Center, LLC Past Accepting new patients
De Craig Ranch, LLC Past Accepting new patients
Dignity Health Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients
Harrison Medical Center Past Accepting new patients
De Craig Ranch, LLC Past Accepting new patients

Locations

2845 Siena Heights Dr
Henderson, NV 89052
Phone (702) 617-1227

2316 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 877-8330

420 N Nellis Blvd
Las Vegas, NV 89110
Phone (702) 339-5710

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1566/brand/2/csg/41/fhir/r4
  • Direct secure messaging: jtan119334@westdirect.optum.com

Organizations & group practices 23

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.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1770794216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35380",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891335380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 SIENA HEIGHTS DR",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890524153",
            "telephone_number": "702-617-7227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "JEFFREY",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60158622",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "16847",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2008990",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SMA MEDICAID",
            "identifier": "1770794216",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09962",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SMA MEDICARE",
            "identifier": "V50547",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

Verify at the official NPI Registry.