Active NPI
Martin Tang, D.O.
- Geriatric Medicine (Family Medicine) Physician
- San Bernardino, CA
National Provider Identifier
1962881466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Family Medicine) Physician
- License
- 20A16127
- Practice address
- 410 E Parkcenter Cir N
San Bernardino, CA 92408-2869 - Phone
- (909) 890-2880
- NPI assigned
- May 29, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 20A16127 | CA | Primary |
Addresses
Primary practice location
410 E Parkcenter Cir N
San Bernardino, CA 92408-2869
Mailing address
410 E Parkcenter Cir N
San Bernardino, CA 92408-2869
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180524002982 | CA | Order and Referring Only - Family Practice | 2062777915 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A16127 | CA | MD | Geriatric Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618963200000",
"number": "1962881466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 E PARKCENTER CIR N",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924082869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 E PARKCENTER CIR N",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924082869",
"telephone_number": "909-890-2880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANG",
"first_name": "MARTIN",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-05-29",
"last_updated": "2021-04-21",
"certification_date": "2021-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "CA",
"license": "20A16127",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; 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.