DEON LYNN TADLOCK (M.D.) – Family Medicine Physician, NPI 1376639583
Family Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
13,194 FAMILY PRACTICE in CA
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Provider Addresses for DEON LYNN TADLOCK (M.D.)
Jackson Post Office, South West Street, Jackson, Hinds County, Mississippi, 39201, United States
JACKSON, CA 956421749
Phone: (209) 223-2030
Fax: (209) 223-2303
Type: Mailing
605, New York Ranch Road, Jackson Rancheria Casino Resort, Jackson, Amador County, California, 95642, United States
JACKSON, CA 956429328
Phone: (209) 223-2030
Fax: (209) 223-2303
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-12-15
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20041215000208 | I | Family Practice | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 639 | 267 | $0 |
| G0008 | Administration of influenza virus vaccine | 177 | 173 | $0 |
| 90662 | Influenza vaccine split virus, preservative free | 173 | 169 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 145 | 145 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 70 | 56 | $0 |
Insurance plans in this area (ZIP 95642)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | CA |
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