Individual provider Active NPI

Candice Ann Ang Tan, MMS, PA-C, RD

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1841745312
Registry record updated Aug 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.007706 Issued in IL
Practice address
1645 W School St Ste a
Chicago, IL 60657-2171
Phone
(773) 227-3669
NPI assigned
Aug 24, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 164.006556 IL
Physician Assistant 363A00000X 085.007706 IL Primary

Addresses

Primary practice location

1645 W School St Ste a
Chicago, IL 60657-2171

Mailing address

1645 W School St Ste a
Chicago, IL 60657-2171
Phone (773) 227-3669

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20201228000571 IL Practitioner - Physician Assistant 5991118580 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of ChicagoGroup PAC ID 7719899426, 1,674 clinicians

Practice addresses (Care Compare)

1101 S Canal St
Suite 201
Chicago, IL 60607-4944
Phone (877) 336-5667

355 E Grand Ave
Chicago, IL 60611-5389
Phone (888) 824-0200

400 Skokie Blvd
Suite 300
Northbrook, IL 60062-7903
Phone (888) 824-0200

5841 S Maryland Ave
Chicago, IL 60637-1443
Phone (773) 702-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
164.006556ILMDRegistered Dietitian
085.007706ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Chicago Medical Center CurrentSince Nov 25, 2020 Accepting new patients
The University of Chicago Medical Center CurrentSince Nov 25, 2020 Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

Organizations & group practices 3

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 3

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": "1471996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596240000000",
    "number": "1841745312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1645 W SCHOOL ST STE A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606572171",
            "telephone_number": "773-227-3669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 W SCHOOL ST STE A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606572171",
            "telephone_number": "773-227-3669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "CANDICE ANN",
        "middle_name": "ANG",
        "credential": "MMS, PA-C, RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-24",
        "last_updated": "2020-08-01",
        "certification_date": "2020-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": "164.006556",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.007706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.