TANNER LINES (MD) – Diagnostic Radiology Physician, NPI 1366062416

TANNER LINES (MD) is a healthcare provider. based in Boston, Massachusetts. specializing in DIAGNOSTIC RADIOLOGY. They hold the professional credentials MD. They hold a License No. 1021815 (MA). The NPI Number for TANNER LINES (MD) is 1366062416

Main info

Male
Sole Proprietor
6 Years Of Experience
Accepts Medicare Assignment
Name
TANNER LINES (MD)
NPI
1366062416
Phone
(617) 724-0288
Address
55 FRUIT ST
Enumeration Date
19 April 2020
Last Update Date
4 June 2025

Doctor Profile

Medical School Name
TEXAS A & M UNIVERSITY SYSTEM, HSC, COLLEGE OF MEDICINE
Secondary Phone
7814856300
Graduation Year
2020 (6 years ago)
PAC ID
7719406933
Group Practice PAC ID
2466365820
Professional Enrollment ID
I20250521001451
Address ID
MA021513675RE300XXAVEX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience41
Completeness75
Years active:6State licenses:1Digital endpointsOther names

1,897 DIAGNOSTIC RADIOLOGY in MA

Provider Addresses for TANNER LINES (MD)

  • 55 FRUIT ST

    BOSTON, MA 021142696

    Phone: (617) 724-0288

    Type: Location

  • 6431 Fannin St Ste Msb 1134

    Houston, TX 770301501

    Phone: (713) 500-6500

    Type: Location

  • 6431 FANNIN ST STE MSB 1134

    HOUSTON, TX 770301501

    Phone: (713) 500-6500

    Type: Location

  • 517 ARBOR BROOK LN

    COPPELL, TX 750194044

    Phone: (214) 202-5897

    Type: Mailing

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: 2025-05-21

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250521001451IDiagnostic RadiologyMATBD

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.

Verify on CMS Revalidation Lookup Tool

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 02114)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2466365820View full group profile
NameSpecialtyState
G A S T R O E N T E R O L O G YMA
Diagnostic RadiologyMA
Nephrology, Internal MedicineMA
Nurse PractitionerMA
P A T H O L O G YNY
P A T H O L O G YMA
P S Y C H I A T R YMA
Cardiac Electrophysiology, Internal Medicine, Cardiovascular Disease (Cardiology)MA
H E M A T O L O G Y/ O N C O L O G YMA
N E U R O L O G YMA

Reviews

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Frequently asked questions

How do payers reference TANNER LINES (MD)?
For TANNER LINES (MD), use NPI 1366062416 as the unique 10-digit identifier.
Is there an active status for TANNER LINES (MD)?
For scheduling context, TANNER LINES (MD) is shown as active in the registry.
What kind of doctor is TANNER LINES (MD)?
TANNER LINES (MD) is associated with Diagnostic Radiology Physician in the directory — Clinical services aligned with this taxonomy classification.
What locale is associated with TANNER LINES (MD)?
Directory geography for TANNER LINES (MD) centers on Boston, Massachusetts.
When was this NPI issued?
Enumeration for TANNER LINES (MD) is noted as April 19, 2020 where the registry provides it.

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