Active NPI
Lily Tam
- Surgery Physician
- Grand Forks, ND
National Provider Identifier
1801526819
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- RL18688
- Practice address
- 1301 N Columbia Rd, Stop 9037
Und Department of Surgery
Grand Forks, ND 58202-9037 - Phone
- (701) 777-3069
- NPI assigned
- Jun 13, 2022
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | RL18688 | ND | Primary |
Addresses
Primary practice location
1301 N Columbia Rd, Stop 9037
Und Department of Surgery
Grand Forks, ND 58202-9037
Mailing address
1301 N Columbia Rd, Stop 9037
Und Department of Surgery
Grand Forks, ND 58202-9037
Phone (701) 777-3069
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220921001589 | ND | Order and Referring Only - General Surgery | 1658756028 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655078400000",
"number": "1801526819",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 N COLUMBIA RD, STOP 9037",
"address_2": "UND DEPARTMENT OF SURGERY",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582029037",
"telephone_number": "701-777-3069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 N COLUMBIA RD, STOP 9037",
"address_2": "UND DEPARTMENT OF SURGERY",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "582029037",
"telephone_number": "701-777-3069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAM",
"first_name": "LILY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-06-13",
"last_updated": "2022-06-13",
"certification_date": "2022-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ND",
"license": "RL18688",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.