Individual provider Active NPI

Tara Tabbaa, PA-C

  • Physician Assistant
  • Willoughby Hills, OH
National Provider Identifier
1003417551
Registry record updated Nov 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.006628RX Issued in OH
Practice address
2570 Som Center Rd
Willoughby Hills, OH 44094-9607
Phone
(440) 943-2500
NPI assigned
Nov 2, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 085.007935 IL
Physician Assistant 363A00000X 085-007935 IL
Physician Assistant 363A00000X 50.006628RX OH Primary

Addresses

Primary practice location

2570 Som Center Rd
Willoughby Hills, OH 44094-9607

Mailing address

6618 Brettin Dr
Independence, OH 44131-6541
Phone (216) 789-5753

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220314000633 OH Practitioner - Physician Assistant 7618362492 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cleveland ClinicGroup PAC ID 1850203555, 6,954 clinicians

Practice addresses (Care Compare)

2570 Som Ctr Rd
Willoughby Hills, OH 44094-9607
Phone (440) 943-2500

29800 Bainbridge Rd
Solon, OH 44139-2202
Phone (216) 444-6568

8950 Euclid Ave
Cleveland, OH 44195-0001
Phone (216) 444-8950

9500 Euclid Ave
Cleveland, OH 44195-0001

Hospital & facility affiliations

  • Cleveland Clinic Hospital, Cleveland, OH, CCN 360180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.007935ILMDFamily Medicine Physician
085-007935ILMDPhysician Assistant
50.006628RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wooster Clinic, LLC CurrentSince Dec 15, 2021 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Dec 15, 2021 Accepting new patients

Locations

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

2570 Som Center Rd
Willoughby Hills, OH 44094
Phone (440) 943-2500

1740 Cleveland Rd
Wooster, OH 44691
Phone (330) 287-4500

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1003417551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6618 BRETTIN DR",
            "city": "INDEPENDENCE",
            "state": "OH",
            "postal_code": "441316541",
            "telephone_number": "216-789-5753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2570 SOM CENTER RD",
            "city": "WILLOUGHBY HILLS",
            "state": "OH",
            "postal_code": "440949607",
            "telephone_number": "440-943-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABBAA",
        "first_name": "TARA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-02",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "085.007935",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-007935",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.006628RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willoughby Hills, OH

Sources for this page

Verify at the official NPI Registry.