Benjo Tan

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95017880 Issued in CA

Practice address

520 N Main St Ste 220
Santa Ana, CA 92701-4623

Phone

(714) 543-5609

NPI assigned

Aug 17, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Access Community Health CenterGroup PAC ID 7810394756, 29 clinicians

New Foundation Medical IncGroup PAC ID 3072893478, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• La Palma Intercommunity Hospital Hospital, La Palma, CA, CCN 050580
• Memorialcare Orange Coast Medical Center Hospital, Fountain Valley, CA, CCN 050678
• Memorialcare Saddleback Medical Center Hospital, Laguna Hills, CA, CCN 050603

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Access Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Santa Ana, CA
  • NPI 1184234726
  Medicare reassignment Care Compare group NPD
• New Foundation Medical Inc.

  • Multi-Specialty Clinic/Center
  • Santa Ana, CA
  • NPI 1689023582
  Medicare reassignment Care Compare group NPD
• Access Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Santa Ana, CA
  • NPI 1245118009
  NPD (past)
• New Day Institute

  • Marriage & Family Therapist
  • Riverside, CA
  • NPI 1043691025
  NPD (past)
• Freeport Memorial Hospital

  • General Acute Care Hospital
  • Freeport, IL
  • NPI 1447228788
  NPD (past)

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

• Orange Coast Memorial Medical Center

  • General Acute Care Hospital
  • Fountain Valley, CA
  • NPI 1497702575
  Care Compare affiliation
• Prime Healthcare la Palma, LLC

  • General Acute Care Hospital
  • La Palma, CA
  • NPI 1417965559
  Care Compare affiliation
• Saddleback Memorial Medical Center

  • General Acute Care Hospital
  • Laguna Hills, CA
  • NPI 1275576381
  Care Compare affiliation

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

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1841966249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "382 N LEMON AVE # 401",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917892344",
            "telephone_number": "949-394-7094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N MAIN ST STE 220",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927014623",
            "telephone_number": "714-543-5609"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20705 Kelfield Dr",
            "address_purpose": "LOCATION",
            "city": "Diamond Bar",
            "state": "CA",
            "postal_code": "91789",
            "country_code": "US",
            "telephone_number": "949-394-7094",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4000 Birch St Ste 112",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926602255",
            "country_code": "US",
            "telephone_number": "949-216-3851",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4000 Birch St Ste 112",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926602255",
            "country_code": "US",
            "telephone_number": "949-629-3730",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16823 Arrow Blvd",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "923353803",
            "country_code": "US",
            "telephone_number": "949-394-7094",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "BENJO",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-17",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95017880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER LICENSE",
            "identifier": "95017880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Tambare
• Estrella Marie Tamburro
• Tamer Shalaby DDS Inc
• Jamshid Tamiry, M.D.
• Kimpee Tamondong, RN
• Darren Anthony Tan
• Jeffrey Tan
• Matthew Hong Gie Tan, MD
• Seng-Tiew Tan, DDS
• Sheila Kathryn Tan, RN

• Psychiatric/Mental Health Nurse Practitioner in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.
• 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.