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DR. MITCHELL GLENN EUSTAQUIO TAN DNP, APRN,PMHNP-BC
NPI 1518787696
Nurse Practitioner - Psychiatric/Mental Health in Rockford, IL

Active since October 14, 2024PECOS EnrolledAccepts Medicare Assignment
1639 N ALPINE RD STE 260, ROCKFORD, IL 61107(815) 670-1715 Get Directions Write a Review

NPPES record last updated: March 25, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Mitchell Glenn Eustaquio Tan Dnp, Aprn,pmhnp-bc NPPES

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

DR. MITCHELL GLENN EUSTAQUIO TAN DNP, APRN,PMHNP-BC (NPI 1518787696) is an individual psychiatric/mental health provider in Rockford, Illinois, licensed in Illinois (209031254) and active in the NPI registry since October 2024. He is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1518787696
Entity TypeIndividualMale
Primary Taxonomy363LP0808X
Provider Legal NameDR. MITCHELL GLENN EUSTAQUIO TANCredential: DNP, APRN,PMHNP-BC
Location Address1639 N ALPINE RD STE 260Rockford, IL 61107-1481
Mailing Address5126 Silver Fox TrlRockford, IL 61114-7010 · (815) 670-1715
Phone(815) 670-1715
Sole ProprietorYes
Medical School CMSOtherGraduated 2024
Enumeration DateOctober 14, 2024
Last NPPES UpdateMarch 25, 2025
NPPES CertifiedMarch 25, 2025
✔ NPI 1518787696 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
Licenses✔ Licensed in IL · 209031254✔ Licensed in MI · 4704421713✔ Licensed in WI · 1632233
Also ListedRegistered NurseTaxonomy 163W00000X · License 041502075 (IL)
1639 N ALPINE RD STE 260, Rockford, IL 61107
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include MercyCare, MercyCare Health Plans, Oscar Health and more.Insurance ›

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

Dr. Mitchell Glenn Eustaquio Tan Dnp, Aprn,pmhnp-bc 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 ID6709306038
PECOS Enrollment IDI20250218000210
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 Mitchell Glenn Tan reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Rockford Psychiatric Medical Services, S.C.
Same address
Psychiatry
1639 N ALPINE RD STE 260
Rockford, IL 61107
  • Reassigned Medicare billing, Illinois enrollment
  • Medicare enrollment name: Rockford Psychiatric Medical Services Sc
  • 163 clinicians in this Medicare group
NPI 1821391442 (815) 395-1500

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61107 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.71 typical visit price
range $54.80 – $168.44
Typical copayment $21.42 (range $13.70 – $42.11)
Most-billed visit code 99203
Established Patient
$97.25 typical visit price
range $17.16 – $136.56
Typical copayment $24.31 (range $4.29 – $34.14)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 10

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

MISTY LYNN DEHAVEN APN
Nurse Practitioner (Family)
1639 N ALPINE RD STE 260
ROCKFORD, IL 61107
Winnebago County (815) 395-1500
MALORI SADE PATRICE HINCHEN APRN
Nurse Practitioner (Psychiatric/Mental Health)
1639 N ALPINE RD STE 260
ROCKFORD, IL 61107
Winnebago County (815) 200-8277
JENNA MCPHILLIPS LCSW
Social Worker (Clinical)
1639 N ALPINE RD STE 260
ROCKFORD, IL 61107
Winnebago County (815) 200-8277
MS. SANDY MEADE NP
Nurse Practitioner (Psychiatric/Mental Health)
1639 N ALPINE RD STE 260
ROCKFORD, IL 61107
Winnebago County (815) 395-1500
ANGELA ELAINE GILBERT
Nurse Practitioner (Family)
1639 N ALPINE RD STE 260
ROCKFORD, IL 61107
Winnebago County (815) 395-1500
CANDICE J HOLDER PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
1639 N ALPINE RD STE 260
ROCKFORD, IL 61107
Winnebago County (815) 395-1500
MS. ANITA ANN THOMAS BUA LCPC,LPC
Counselor (Mental Health)
1639 N ALPINE RD STE 260
ROCKFORD, IL 61107
Winnebago County (815) 395-1500
MRS. CASI LYNNE KRALL M.S., L.C.P.C.
Counselor (Professional)
1639 N ALPINE RD STE 260
ROCKFORD, IL 61107
Winnebago County (815) 514-0768

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 Mitchell Glenn Tan's NPI number?

The NPI number for Mitchell Glenn Tan is 1518787696. It was assigned to this individual provider in the NPPES registry on October 14, 2024.

Where is Mitchell Glenn Tan located?

Mitchell Glenn Tan practices at 1639 N Alpine Rd Ste 260, Rockford, IL 61107. The listed phone number is (815) 670-1715.

What is Mitchell Glenn Tan's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Mitchell Glenn Tan enrolled in Medicare?

Yes. Mitchell Glenn 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 Mitchell Glenn Tan's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mitchell Glenn Tan reassigns Medicare benefits to Rockford Psychiatric Medical Services, S.C. (Rockford, IL). 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 Mitchell Glenn Tan's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mitchell Glenn Tan accept?

Health plans from MercyCare, MercyCare Health Plans, Oscar Health and Quartz list Mitchell Glenn Tan as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mitchell Glenn Tan was last updated on March 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.