Individual provider Active NPI

Tari Leanne Tribble, PA-C

  • Physician Assistant
  • West Sacramento, CA
National Provider Identifier
1073671038
Registry record updated Jan 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA15699 Issued in CA
Practice address
2101 Stone Blvd #190
West Sacramento, CA 95691
Phone
(916) 371-4939
Fax
(916) 371-4226
NPI assigned
Dec 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA15699 CA Primary

Addresses

Primary practice location

2101 Stone Blvd #190
West Sacramento, CA 95691

Mailing address

2101 Stone Blvd #190
West Sacramento, CA 95691
Phone (916) 371-4939

Other names 1

  • Tari Leanne Smith Former name

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20070604000417 CA Practitioner - Physician Assistant 1153429840 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA15699CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Garcia, Lee & Concepcion Medical Group CurrentSince Oct 1, 2017 Accepting new patients

Locations

7248 S Land Park Dr
Ste 205
Sacramento, CA 95831
Phone (916) 392-4000

2101 Stone Blvd
Ste 190
West Sacramento, CA 95691
Phone (916) 371-4939

Interoperability endpoints

  • Direct secure messaging: ttribble14449@hpmg.direct-ci.net
  • Direct secure messaging: tari.tribble.1@18067.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548892800000",
    "number": "1073671038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 STONE BLVD #190",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "95691",
            "telephone_number": "916-371-4939",
            "fax_number": "916-371-4226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 STONE BLVD #190",
            "city": "WEST SACRAMENTO",
            "state": "CA",
            "postal_code": "95691",
            "telephone_number": "916-371-4939",
            "fax_number": "916-371-4226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIBBLE",
        "first_name": "TARI",
        "middle_name": "LEANNE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2019-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARI",
            "last_name": "SMITH",
            "middle_name": "LEANNE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in West Sacramento, CA

Sources for this page

Verify at the official NPI Registry.