Tara Shannon Condrey, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9104580 Issued in FL

Practice address

11512 Lake Mead Ave
Suite 531
Jacksonville, FL 32256-9680

Phone

(904) 419-2054

NPI assigned

May 21, 2008

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

Other names 1

• Tara Wall Other name

Medicare fee-for-service enrollment

Enrolled in FL

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

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida ENT Associates IncGroup PAC ID 4587556923, 156 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Medical Center - Jacksonville Hospital, Jacksonville, FL, CCN 100088
• Brooks Rehabilitation Hospital University Campus Inpatient rehabilitation facility, Jacksonville, FL, CCN 103039

Merit-based Incentive Payment System (MIPS)

Final score

55.52 of 100Reported as group

Quality

67.92

Promoting interoperability

0

Improvement activities

40

Cost

67.15

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Florida ENT Associates, Inc.

  • Otolaryngology Physician
  • West Miami, FL
  • NPI 1184625733
  Medicare reassignment Care Compare group NPD
• Charles C Greene MD PHD PA

  • Otolaryngology Physician
  • Jacksonville, FL
  • NPI 1457600769
  Medicare reassignment
• Charles C Greene MD PHD PA

  • Otolaryngology Physician
  • Jacksonville, FL
  • NPI 1609125913
  NPD

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

• Genesis Rehabilitation Hospital, Inc.

  • Rehabilitation Hospital
  • Jacksonville, FL
  • NPI 1376114413

  Inpatient rehabilitation facility

  Care Compare affiliation
• Genesis Rehabilitation Hospital, Inc.

  • Rehabilitation Hospital
  • Jacksonville, FL
  • NPI 1912947748

  Inpatient rehabilitation facility

  Care Compare affiliation
• Southern Baptist Hospital of Florida Inc

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1578620449
  Care Compare affiliation

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1083871693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15280 NW 79TH CT STE 200",
            "city": "MIAMI LAKES",
            "state": "FL",
            "postal_code": "330165873",
            "telephone_number": "305-558-3724",
            "fax_number": "786-907-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE",
            "address_2": "SUITE 531",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322569680",
            "telephone_number": "904-419-2054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDREY",
        "first_name": "TARA",
        "middle_name": "SHANNON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-21",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9104580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2930951-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "WALL",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kerry Haffey Condit, PHD
• Tonya Ruth Condit, FNP-C
• Melissa Condo, QASP
• Lauren Condon
• Niamh A Condon, DO
• Lily Yarbrough Condy, OTR/L
• Paul J Cone, O. D.
• Donald Anthony Conetta, M.D.
• Deja Coney
• Evelyn Donita Coney, BS

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.