Individual provider Active NPI

Tara Joan, ANP AND GNP

  • Adult Health Nurse Practitioner
  • Bronx, NY
National Provider Identifier
1063979896
Registry record updated Jul 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F302878 Issued in NY
Practice address
2015 Grand Concourse
Bronx, NY 10453-4303
Phone
(718) 299-7295
Fax
(718) 299-6797
NPI assigned
Feb 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X F340417 NY
Adult Health Nurse Practitioner 363LA2200X F302878 NY Primary

Addresses

Primary practice location

2015 Grand Concourse
Bronx, NY 10453-4303

Mailing address

1434 Williamsbridge Rd FL 2
Bronx, NY 10461-2507
Phone (718) 618-0401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20200821002388 NY Practitioner - Nurse Practitioner 5193141042 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edward Timothy Okelley MD PCGroup PAC ID 8729437793, 11 clinicians

Practice addresses (Care Compare)

155 Crystal Run Rd
Middletown, NY 10941-4028
Phone (888) 725-5422

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F340417NYMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Damian Family Care Centers, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Damian Family Care Centers, Inc. CurrentSince Mar 1, 2020 Accepting new patients
Essen Medical Associates, PC CurrentSince Jun 1, 2020 Accepting new patients
House Call Medical Services of New York, PLLC CurrentSince Jun 1, 2020 Accepting new patients
Edward Timothy Okelley MD PC CurrentSince Aug 19, 2025 Accepting new patients
Bronx Medical Practice P.C. CurrentSince Jun 1, 2020 Accepting new patients
Essen Medical Associates, PC CurrentSince Jun 1, 2020 Accepting new patients

Locations

2015 Grand Concourse
#13202
Bronx, NY 10453

1434 Williamsbridge Rd
Fl 2
Bronx, NY 10461
Phone (201) 641-2125

2015 Grand Concourse
Bronx, NY 10453
Phone (718) 294-6200

1371 Seabury Ave
Bronx, NY 10461
Phone (718) 294-6200

2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400

8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400

8956 162nd St
#3
Jamaica, NY 11432
Phone (718) 297-8000

13750 Jamaica Ave
Jamaica, NY 11435
Phone (718) 298-5100

155 Crystal Run Rd
Middletown, NY 10941

Interoperability endpoints

  • Direct secure messaging: tara.joan.1@26850.direct.athenahealth.com

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1551312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1063979896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1434 WILLIAMSBRIDGE RD FL 2",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612507",
            "telephone_number": "718-618-0401",
            "fax_number": "347-479-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104534303",
            "telephone_number": "718-299-7295",
            "fax_number": "718-299-6797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOAN",
        "first_name": "TARA",
        "credential": "ANP AND GNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-28",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NY",
            "license": "F340417",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F302878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.