Nelly Tan, MD

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

60018 Issued in AZ

Practice address

757 Westood PLZ
Rrumc 1621; Mailcode: 743730
Los Angeles, CA 90095-8358

Phone

(310) 957-9021

NPI assigned

Jul 7, 2008

Reactivated

Apr 9, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, AZ2 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

Specialty

Radiation OncologyAlso: Diagnostic Radiology

Education

University of California, Geffen School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mayo Clinic ArizonaGroup PAC ID 7012829930, 1,618 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mayo Clinic Hospital Hospital, Phoenix, AZ, CCN 030103

Merit-based Incentive Payment System (MIPS)

Final score

86.47 of 100Reported as group

Quality

78.27

Promoting interoperability

100

Improvement activities

40

Cost

76.62

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ntan140140@direct.llu.edu
• Direct secure messaging: ntan1186035@ehrdirect.mayoclinicmsg.org

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.

• Mayo Clinic Arizona

  dba Mayo Clinic Scottsdale

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1558332494
  Medicare reassignment Care Compare group NPD
• County of Los Angeles

  dba County of Los Angeles Harbor UCLA Medical Center

  • General Acute Care Hospital
  • Torrance, CA
  • NPI 1851363188
  Medicare reassignment NPD
• Faculty Physicians and Surgeons of Llusm

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Apple Valley, CA
  • NPI 1205009917
  Medicare reassignment NPD
• Mayo Clinic Jacksonville

  • Multi-Specialty Clinic/Center
  • Jacksonville, FL
  • NPI 1790772317

  AZ

  Medicare reassignment NPD
• Beaumont Radiology Services LLC

  dba Highland Springs Imaging Center

  • Radiology Clinic/Center
  • Beaumont, CA
  • NPI 1629212840
  NPD
• County of Los Angeles

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1295407401
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1558788331
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1679043400
  NPD
• Mayo Clinic Arizona

  • Durable Medical Equipment & Medical Supplies
  • Phoenix, AZ
  • NPI 1699520049
  NPD
• Mayo Clinic Jacksonville

  dba Mayo Clinic Jacksonville advanced care at home

  • Health Service Clinic/Center
  • Jacksonville, FL
  • NPI 1174143986
  NPD

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

• Mayo Clinic Arizona

  dba Mayo Clinic Hospital

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1154392231
  Care Compare affiliation

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

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666051200000",
    "number": "1871756254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "757 WESTWOOD PLAZA",
            "address_2": "RONALD REGAN UCLA MEDICAL CENTER",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90095",
            "telephone_number": "310-267-8758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "757 WESTOOD PLZ",
            "address_2": "RRUMC 1621; MAILCODE: 743730",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958358",
            "telephone_number": "310-957-9021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5777 E Mayo Blvd",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850544502",
            "country_code": "US",
            "telephone_number": "480-342-1800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4500 San Pablo Rd S",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322241865",
            "country_code": "US",
            "telephone_number": "904-953-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAN",
        "first_name": "NELLY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-07",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "deactivation_date": "2020-02-07",
        "reactivation_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "FL",
            "license": "ME148615",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A114724",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "AZ",
            "license": "60018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ntan1186035@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "5777 E Mayo Blvd",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850544502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mark Vincent Syki Tan
• Matthew S Tan, M.D.
• Michael Hock En Tan
• Michelle Tan, PA-C
• Mitchell Ejercito Tan, RN
• Nemuel Biejay Tan, DC
• Olivia Campbell Tan, M.S., C.G.C.
• Patricia Z Tan, PH.D.
• Ricardo Antonio Tan, MD
• Salinas Tan, LCSW 80386

• Radiation Oncology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Radiation Oncology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.