Individual provider Active NPI

Tony Tan

  • Physician Assistant
  • Las Vegas, NV
National Provider Identifier
1972998391
Registry record updated Jun 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA0310 Issued in NV
Practice address
4835 S Durango Dr
Las Vegas, NV 89147-8171
Phone
(702) 877-5199
NPI assigned
Apr 2, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2016

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 PA0310 NV Primary

Addresses

Primary practice location

4835 S Durango Dr
Las Vegas, NV 89147-8171

Mailing address

PO Box 15645
Las Vegas, NV 89114-5645
Phone (702) 877-8600

Other identifiers 1

IdentifierTypeStateIssuer
1972998391MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20150528001532 NV Practitioner - Physician Assistant 1052631355 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geiss Med Nevada PCGroup PAC ID 8921400599, 16 clinicians
Urgent Care Nevada LLCGroup PAC ID 7012137037, 106 clinicians

Practice addresses (Care Compare)

3753 Howard Hughes Pkwy
Suite 200
Las Vegas, NV 89169-0952
Phone (855) 434-7763

4075 S Durango Dr
Suite 108
Las Vegas, NV 89147-4164
Phone (701) 701-9509

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA0310NVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Urgent Care Nevada, LLC CurrentSince Apr 27, 2026 Accepting new patients

Locations

4075 S Durango Dr
Ste 108
Las Vegas, NV 89147
Phone (701) 701-9509

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 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": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465257600000",
    "number": "1972998391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15645",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891145645",
            "telephone_number": "702-877-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4835 S DURANGO DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891478171",
            "telephone_number": "702-877-5199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAN",
        "first_name": "TONY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-02",
        "last_updated": "2016-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA0310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1972998391",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.