Individual provider Active NPI

Tara Rose-Sukhapinda Secor, D.O.

  • Anesthesiology Physician
  • Fredericksburg, VA
National Provider Identifier
1073048831
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
0102206562 Issued in VA
Practice address
1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453
Phone
(540) 741-1100
NPI assigned
Apr 28, 2017
Last updated
Jul 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X OT017647 PA
Anesthesiology Physician 207L00000X 0102206562 VA Primary

Addresses

Primary practice location

1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453

Mailing address

1500 Highlands Dr
Lititz, PA 17543-7694
Phone (717) 625-5000

Other practice location 1

1500 Highlands Dr
Lititz, PA 17543-7694
Phone (717) 625-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210805000700 VA Practitioner - Anesthesiology 9335419829 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mary Washington Healthcare Specialty Services, LLCGroup PAC ID 5991605826, 136 clinicians

Practice addresses (Care Compare)

1001 Sam Perry Blvd
Fredericksburg, VA 22401-4453
Phone (540) 741-7614

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OT017647PAMDAnesthesiology Physician
0102206562VAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Washington Healthcare Specialty Services LLC Anesthesiology CurrentSince Jan 1, 2025 Accepting new patients
American Anesthesiology of Virginia, PC Anesthesiology CurrentSince Jun 12, 2021 Accepting new patients
American Anesthesiology of Virginia PC Anesthesiology Current Accepting new patients

Locations

1201 Sam Perry Blvd
Ste 101
Fredericksburg, VA 22401
Phone (540) 741-4614

1001 Sam Perry Blvd
Fredericksburg, VA 22401
Phone (540) 741-1100

19455 Deerfield Ave
Ste 204
Leesburg, VA 20176
Phone (703) 724-9950

101 Hospital Center Blvd
Stafford, VA 22554
Phone (540) 741-3340

Interoperability endpoints

  • Direct secure messaging: tsecor74817@marywashingtonhealthcare.direct-ci.com

Organizations & group practices 3

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

Hospital & facility affiliations 4

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": "1493337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1073048831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 HIGHLANDS DR",
            "city": "LITITZ",
            "state": "PA",
            "postal_code": "175437694",
            "telephone_number": "717-625-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SAM PERRY BLVD",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014453",
            "telephone_number": "540-741-1100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 Highlands Dr",
            "address_purpose": "LOCATION",
            "city": "Lititz",
            "state": "PA",
            "postal_code": "175437694",
            "country_code": "US",
            "telephone_number": "717-625-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SECOR",
        "first_name": "TARA",
        "middle_name": "ROSE-SUKHAPINDA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-28",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "OT017647",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0102206562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

Verify at the official NPI Registry.