Individual provider Active NPI

Tanith M. Graham, MD

  • Anesthesiology Physician
  • Portland, OR
National Provider Identifier
1790752640
Registry record updated Jan 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
09591 Issued in MS
Practice address
2869 SW Champlain Dr
Portland, OR 97205-5833
Phone
(503) 709-8787
NPI assigned
Feb 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD13201 OR
Pain Medicine (Anesthesiology) Physician 207LP2900X MD13201 OR
Anesthesiology Physician 207L00000X 09591 MS Primary

Addresses

Primary practice location

2869 SW Champlain Dr
Portland, OR 97205-5833

Mailing address

2500 N State St
Jackson, MS 39216-4500
Phone (601) 815-1196

Other identifiers 5

IdentifierTypeStateIssuer
1037381MedicaidWA
7394381-00MedicaidMN
02121230MedicaidMS
050032614OtherORRR MEDICARE
117006MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, MS2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20101019000268 OR Practitioner - Anesthesiology 9638362072 Reassigns benefits to 1 organization
I20170803003408 MS Practitioner - AnesthesiologyPractitioner - Pain Management 9638362072 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Pain Management
Education
University of Mississippi School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2500 N State St
Jackson, MS 39216-4500
Phone (601) 898-4404

Hospital & facility affiliations

  • University of Mississippi Med Center Hospital, Jackson, MS, CCN 250001

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
67.75
Promoting interoperability
100
Improvement activities
40
Cost
71.17

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD13201ORMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Oct 9, 2017 Accepting new patients
State of Mississippi-University of Mississippi Medical Center CurrentSince Oct 9, 2017 Accepting new patients
State of Mississippi - University of Mississippi Medical Center Current Accepting new patients
Oregon Anesthesiology Group PC Anesthesiology CurrentSince Jul 10, 1982 Accepting new patients
Lifelinc Anesthesia, PLLC Anesthesiology CurrentSince Jul 19, 2017 Accepting new patients

Locations

163 River Oaks Dr
Ste 204
Canton, MS 39046
Phone (601) 855-4880

634 Leigh Dr
Columbus, MS 39705
Phone (601) 978-3393

965 Avent Dr
Ste 100A
Grenada, MS 38901
Phone (662) 227-7000

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

2124 14th St
Meridian, MS 39301
Phone (601) 483-8811

499 Azalea Dr
Oxford, MS 38655
Phone (662) 234-7979

707 SW Washington St
Ste 700
Portland, OR 97205

Interoperability endpoints

  • Direct secure messaging: tgraham80697@ummc.direct-ci.com

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516233600000",
    "number": "1790752640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-1196",
            "fax_number": "601-984-5939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2869 SW CHAMPLAIN DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972055833",
            "telephone_number": "503-709-8787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "TANITH",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2018-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD13201",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "OR",
            "license": "MD13201",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MS",
            "license": "09591",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1037381",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7394381-00",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02121230",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "050032614",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117006",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.