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  7. NPI Record 1487186698

TUCKER VAN RENSSELAER BURR MD
Complete NPI Record 1487186698
Radiology - Diagnostic Radiology in Los Angeles, CA


Quality Rating: 75.06 out of 100 score

NPI Status: Active since March 28, 2017

Contact Information

757 WESTWOOD PLZ
LOS ANGELES, CA
ZIP 90095
Phone: (310) 825-9111

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Enumeration Date
  19. Last Update Date
  20. Provider Gender Code
  21. Healthcare Provider Taxonomy Code 1
  22. Provider License Number 1
  23. Provider License Number State Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Healthcare Provider Taxonomy Code 2
  26. Provider License Number 2
  27. Provider License Number State Code 2
  28. Healthcare Provider Primary Taxonomy Switch 2
  29. Is Sole Proprietor
  30. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1487186698. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1487186698
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Entity Type Code: 1
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider First Name: TUCKER
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Middle Name: VAN RENSSELAER
The country code in the location address of the provider being identified.
Provider Credential Text: MD
The telephone number associated with the location address of the provider being identified.
Provider First Line Business Mailing Address: 5767 W CENTURY BLVD STE 400
The State code in the location of the provider being identified.
Provider Business Mailing Address City Name: LOS ANGELES
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Mailing Address State Name: CA
The date that a record was last updated or changed.
Provider Business Mailing Address Postal Code: 900455631
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Provider Business Mailing Address Country Code If outside U S : US
The first name of the authorized official.
Provider First Line Business Practice Location Address: 757 WESTWOOD PLZ
The title or position of the authorized official.
Provider Business Practice Location Address City Name: LOS ANGELES
The 10-position telephone number of the authorized official.
Provider Business Practice Location Address State Name: CA
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider Business Practice Location Address Postal Code: 900958358
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 3108259111
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 3/28/2017
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 10/27/2023
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider Gender Code: M
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Taxonomy Code 1: 2085R0202X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 1487186698
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: IL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 2085R0202X
Provider License Number 2: A176487
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: CA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: Y
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 6/23/2022