Kendra Walker Tan, MD

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

DR.0073399 Issued in CO

Practice address

2060 Briargate Pkwy Ste 150
Colorado Springs, CO 80920-7660

Phone

(719) 471-1763

Fax

(719) 471-2498

NPI assigned

May 25, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Kendra Montayne Walker Former name

Medicare fee-for-service enrollment

Enrolled in CO

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

Dermatology

Education

Texas Tech University Health Science Center School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Colorado Springs Dermatology Clinic, P.C.Group PAC ID 2264424738, 11 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ktan@csderm.emadirect.md

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.

• Colorado Springs Dermatology Clinic, P.C.

  • MOHS-Micrographic Surgery Physician
  • Colorado Springs, CO
  • NPI 1801901517

  Dermatology

  Medicare reassignment Care Compare group NPD
• Colorado Springs Dermatology Clinic, P.C.

  • MOHS-Micrographic Surgery Physician
  • Pueblo, CO
  • NPI 1386241453

  Dermatology

  NPD
• Colorado Springs Dermatology Clinic, P.C.

  • MOHS-Micrographic Surgery Physician
  • Colorado Springs, CO
  • NPI 1891392973

  Dermatology

  NPD

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

{
    "created_epoch": "1558742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724716800000",
    "number": "1780241679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR DEPT INTERNAL",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-467-2000",
            "fax_number": "319-384-8955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 BRIARGATE PKWY STE 150",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809207660",
            "telephone_number": "719-471-1763",
            "fax_number": "719-471-2498"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Hawkins Dr Dept Internal",
            "address_purpose": "LOCATION",
            "city": "Iowa City",
            "state": "IA",
            "postal_code": "522421009",
            "country_code": "US",
            "telephone_number": "319-467-2000",
            "fax_number": "319-384-8955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "KENDRA",
        "middle_name": "WALKER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-25",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CO",
            "license": "DR.0073399",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IA",
            "license": "MD-49793",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MO",
            "license": "MD-49793",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENDRA",
            "last_name": "WALKER",
            "middle_name": "MONTAYNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rachel Tamayo, RBT
• Caitlin Tamblyn
• Teryn Tamblyn
• Gina Michelle Tambone, LPC
• Marissa Tamez
• Percivil Tan, LPC
• Sarah N Tan, MA, LPC
• Robert M Tanabe, MD
• Chanda Tanaka, BSN, RN
• Jacqueline Sue Tanaka, BCABA

• MOHS-Micrographic Surgery Physician in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• MOHS-Micrographic Surgery Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.