Individual provider Active NPI

Carmela Chua Tan, P.A.-C.

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1811069271
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA18675 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9000
Phone
(800) 926-8273
Fax
(888) 539-8781
NPI assigned
Nov 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA18675 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9000

Mailing address

File 57326
Los Angeles, CA 90074-0001

Other practice location 1

10666 N Torrey Pines Rd
LA Jolla, CA 92037-1027
Phone (858) 554-8984

Other practice location 2

9300 Campus Point Dr
LA Jolla, CA 92037-1300
Phone (800) 926-8273

Other identifiers 3

IdentifierTypeStateIssuer
A078OtherCHAMPUS
0PA186750OtherBLUE SHIELD OF CA
PA18675MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070329000450 CA Practitioner - Physician Assistant 3072617174 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Regents of the University of CaliforniaGroup PAC ID 3577476761, 2,047 clinicians

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (858) 657-7000

447 N El Camino Real
Encinitas, CA 92024-1302
Phone (858) 657-7000

6655 Alvarado Rd
San Diego, CA 92120-5208
Phone (800) 926-8273

9300 Campus Point Dr
La Jolla, CA 92037-1300
Phone (800) 926-8273

9350 Campus Point Dr
La Jolla, CA 92037-1300
Phone (800) 926-8273

Hospital & facility affiliations

  • UC San Diego Health Hillcrest - Hillcrest Med Ctr Hospital, San Diego, CA, CCN 050025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
18675CAMDSports Physician Chiropractor
PA18675CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Jun 10, 2024 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Clinic Medical Group, Inc Past Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients

Locations

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

9300 Campus Point Dr
La Jolla, CA 92037
Phone (619) 957-7000

10666 N Torrey Pines Rd
La Jolla, CA 92037
Phone (858) 554-2626

9350 Campus Point Dr
La Jolla, CA 92037
Phone (858) 657-0583

File 57326
Los Angeles, CA 90074

6655 Alvarado Rd
San Diego, CA 92120
Phone (619) 229-3130

6645 Alvarado Rd
San Diego, CA 92120
Phone (619) 229-3172

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

9730 Summers Ridge Rd
#100
San Diego, CA 92121
Phone (858) 549-7400

Interoperability endpoints

  • Direct secure messaging: ctan10807@scrippshlth.medalliesdirect.net

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": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1811069271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 57326",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900740001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "800-926-8273",
            "fax_number": "888-539-8781"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10666 N Torrey Pines Rd",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920371027",
            "country_code": "US",
            "telephone_number": "858-554-8984",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9300 Campus Point Dr",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920371300",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "fax_number": "888-539-8781",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "CARMELA",
        "middle_name": "CHUA",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18675",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "A078",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "0PA186750",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA18675",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.