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

Q: 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.

Q: 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.

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: August 02, 2026.

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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 Health Plans, Quartz.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

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)