Alisa Tarasova, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R0120108 Issued in OK

Practice address

304 S 29TH St
Chickasha, OK 73018-2501

Phone

(058) 968-0584

Fax

(855) 223-1999

NPI assigned

Dec 20, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

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

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ennoble HC NJ PCGroup PAC ID 0345638185, 129 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Phoenix Home Health Agency, LLC Home health agency, Spencer, OK, CCN 377717

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19281/brand/1/csg/1/fhir/r4

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.

• Ennoble HC NJ PC

  • Geriatric Medicine (Family Medicine) Physician
  • Hackensack, NJ
  • NPI 1306500764

  OK

  Medicare reassignment Care Compare group NPD
• Physician Housecalls LLC

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1528480811
  Medicare reassignment NPD
• Ennoble HC NJ II PC

  • Geriatric Medicine (Family Medicine) Physician
  • Hackensack, NJ
  • NPI 1871475806

  OK

  Medicare reassignment NPD
• Ennoble HC NJ III PC

  • Geriatric Medicine (Family Medicine) Physician
  • Hackensack, NJ
  • NPI 1043192099

  OK

  Medicare reassignment NPD

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

• Phoenix Home Health Agency, LLC

  • Home Health Agency
  • Spencer, OK
  • NPI 1326186800
  Care Compare affiliation

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

{
    "created_epoch": "1545264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1043782634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 929",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730230929",
            "telephone_number": "405-896-8058",
            "fax_number": "855-223-1999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 S 29TH ST",
            "city": "CHICKASHA",
            "state": "OK",
            "postal_code": "730182501",
            "telephone_number": "058-968-0584",
            "fax_number": "855-223-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARASOVA",
        "first_name": "ALISA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-20",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0120108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14383187",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mendy Stone, BS PSYCHOLOGY
• Bruce Leon Storms, M.D.
• Sue Stuke
• Summer Leggett
• Lindy Nicole Summerford, BS
• Marcella Tarpley
• Bailee A Taylor, BHRS
• Brianna Taylor
• Corinna Taylor
• Justin Taylor

• Family Nurse Practitioner in Chickasha, OK
• Providers in Chickasha, OK by specialty
• Family Nurse Practitioner in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.