Tara Lynn Shafer, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95015152 Issued in CA

Practice address

1350 W 6TH St Ste 200
San Pedro, CA 90732-3508

Phone

(310) 832-0686

NPI assigned

Aug 16, 2020

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

Medicare fee-for-service enrollment

Enrolled in CA

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Array Skin Therapy a Medical CorporationGroup PAC ID 1557534278, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Array Skin Therapy, a Medical Corporation

  • Dermatology Physician
  • Mission Viejo, CA
  • NPI 1891075123
  Medicare reassignment Care Compare group NPD
• James A Schmidt, MD

  • Family Medicine Physician
  • San Pedro, CA
  • NPI 1336243666
  Medicare reassignment

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

{
    "created_epoch": "1597536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597536000000",
    "number": "1053922641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 N CATALINA AVE UNIT B",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902772830",
            "telephone_number": "410-916-8483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 W 6TH ST STE 200",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323508",
            "telephone_number": "310-832-0686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFER",
        "first_name": "TARA",
        "middle_name": "LYNN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-16",
        "last_updated": "2020-08-16",
        "certification_date": "2020-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95015152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Robert Seibert, R.PH.
• Caleb Seip, 16287-RAC
• Serenity Villa Jja, Inc
• Michelle Lynn Sereno
• Elizabeth Servaites, NP
• Shaffer Psychological Institute
• Stuart M Shaffer, PH.D.
• Krupa Shah, M.D.
• Mona S Shah, MD
• Shamrock Healthcare Services

• Family Nurse Practitioner in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2020; 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.