JONAH O. TAN M.P.T., P.A.-C
NPI 1477569010
Physician Assistant in Simi Valley, CA
About Jonah O. Tan M.p.t., P.a.-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JONAH O. TAN M.P.T., P.A.-C (NPI 1477569010) is an individual physician assistant in Simi Valley, California, licensed in California (PA16970) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS and is a graduate of Other (2003).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jonah O. Tan M.p.t., P.a.-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Jonah Tan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Simi Valley, CA 93065
- Reassigned Medicare billing, California enrollment
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 2
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 93065 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 3
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
SIMI VALLEY, CA 93065
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 Jonah Tan's NPI number?
The NPI number for Jonah Tan is 1477569010. It was assigned to this individual provider in the NPPES registry on August 1, 2006.
Where is Jonah Tan located?
Jonah Tan practices at 3200 E Los Angeles Ave Suite 20, Simi Valley, CA 93065. The listed phone number is (805) 581-4266.
What is Jonah Tan's specialty?
The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.
Is Jonah Tan enrolled in Medicare?
Yes. Jonah Tan is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Jonah Tan's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jonah Tan reassigns Medicare benefits to Divine Health Provider Physical Therapy Inc (Simi Valley, 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 Jonah 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 Jonah Tan was last updated on June 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months 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.
# Jonah O. Tan, M.P.T., P.A.-C · NPI 1477569010
Physician Assistant physician in Simi Valley, California. Individual provider, active in the CMS NPPES registry since August 1, 2006.
## Identity
- **NPI:** 1477569010 (Entity type: Individual)
- **Enumerated:** August 1, 2006
- **Primary specialty:** Physician Assistant · taxonomy 363A00000X
- **State license:** PA16970 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 3200 E LOS ANGELES AVE, SUITE 20, Simi Valley, CA 93065-3972
- **Phone:** (805) 581-4266 · **Fax:** (805) 581-5049
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Divine Health Provider Physical Therapy Inc (NPI 1386899763, Simi Valley, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2003
## Record status
- **NPPES last updated:** June 24, 2026
---
Source: [NPI Profile](https://npiprofile.com/npi/1477569010) · Data from the CMS NPPES public registry.