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NICHOLAS GAN TAN D.P.M.
NPI 1346657327
Podiatrist - Foot & Ankle Surgery in Vallejo, CA

Active since July 22, 2014PECOS EnrolledAccepts Medicare Assignment
975 SERENO DR, VALLEJO, CA 94589(909) 633-2881 Get Directions Write a Review

NPPES record last updated: December 6, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Nicholas Gan Tan D.p.m. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICHOLAS GAN TAN D.P.M. (NPI 1346657327) is an individual foot & ankle surgery provider in Vallejo, California, licensed in California (EL6709) and active in the NPI registry since July 2014. He is enrolled in Medicare PECOS and is a graduate of Temple University School Of Medicine (2014).

NPPES Registry Identity

NPI1346657327
Entity TypeIndividualMale
Primary Taxonomy213ES0103X
Provider Legal NameNICHOLAS GAN TANCredential: D.P.M.
Location Address975 SERENO DRVallejo, CA 94589-2441
Mailing Address521 Greenbriar CirPetaluma, CA 94954-3528 · (909) 633-2881
Phone(909) 633-2881
Sole ProprietorNo
Medical School CMSTemple University School Of MedicineGraduated 2014
Enumeration DateJuly 22, 2014
Last NPPES UpdateDecember 6, 2021
✔ NPI 1346657327 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatrist · Foot & Ankle SurgeryPodiatric Medicine & Surgery Service Providers
Taxonomy Code213ES0103X
License✔ Licensed in CA · EL6709
975 SERENO DR, Vallejo, CA 94589
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Nicholas Gan Tan D.p.m. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2860735396
PECOS Enrollment IDI20190523001856
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Nicholas Tan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
257 mi
Health Maintenance Organization
9100 ROSEDALE HWY
Bakersfield, CA 93312
  • Reassigned Medicare billing, California enrollment
  • 5,228 clinicians in this Medicare group
NPI 1316572753 (877) 608-0044

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ROBERTA YIWUN WANG M.D.
Physical Medicine & Rehabilitation
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-5128
RIHONG ZHOU
Pharmacist
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-2072
EVAN HIRSCHBEIN
Student in an Organized Health Care Education/Training Program
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 339-2074
MS. JEAN BROADNAX LCSW
Social Worker (Clinical)
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-4423
SEAN NISAM
Student in an Organized Health Care Education/Training Program
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-4071
LI M. TSANG MD
Anesthesiology
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-1000
DONN R. ERICKSON MD
Family Medicine
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-1000
JOHN S. WOOD MD
Surgery
975 SERENO DR
VALLEJO, CA 94589
Napa County (707) 651-1000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Nicholas Tan's NPI number?

The NPI number for Nicholas Tan is 1346657327. It was assigned to this individual provider in the NPPES registry on July 22, 2014.

Where is Nicholas Tan located?

Nicholas Tan practices at 975 Sereno Dr, Vallejo, CA 94589. The listed phone number is (909) 633-2881.

What is Nicholas Tan's specialty?

The primary specialty registered for this NPI is Podiatrist, specializing in Foot & Ankle Surgery, with taxonomy code 213ES0103X.

Is Nicholas Tan enrolled in Medicare?

Yes. Nicholas Tan is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Nicholas Tan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Nicholas Tan reassigns Medicare benefits to Southern California Permanente Medical Group (Bakersfield, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Nicholas Tan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Nicholas Tan was last updated on December 6, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.