Individual provider Active NPI

Tara Lynn Zickerman, P.A.

  • Physician Assistant
  • Roslyn, NY
National Provider Identifier
1093840605
Registry record updated Apr 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
006110 Issued in NY
Practice address
100 Port Washington Blvd
Roslyn, NY 11576-1353
Phone
(516) 338-5300
NPI assigned
Feb 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2009

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 006110 NY Primary

Addresses

Primary practice location

100 Port Washington Blvd
Roslyn, NY 11576-1353

Mailing address

PO Box 1048
Port Washington, NY 11050-1048
Phone (516) 338-5300

Other names 1

  • Tara Lynn Cunningham Former name

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
I20090529000043 NY Practitioner - Physician Assistant 5890844559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHS Physician Partners PCGroup PAC ID 7618955667, 739 clinicians

Practice addresses (Care Compare)

100 Port Washington Blvd
Roslyn, NY 11576-1347

1000 N Village Ave
Rockville Center, NY 11570-1000

2200 Northern Blvd
Greenvale, NY 11548-1219
Phone (516) 325-7310

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
CHS Physician Partners, PC CurrentSince Jan 1, 2016 Accepting new patients
CHS Physician Partners, P.C CurrentSince Jan 1, 2016 Accepting new patients
St Francis Hospital Past Accepting new patients
St Francis Hospital United States Catholic Conference Past Accepting new patients

Locations

2200 Northern Blvd
Ste 111
Greenvale, NY 11548
Phone (516) 325-7500

245 Old Country Rd
Melville, NY 11747
Phone (631) 465-6141

1000 N Village Ave
Rockville Ctr, NY 11570
Phone (516) 705-1012

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

100 Port Washington Blvd
Ste G3
Roslyn, NY 11576
Phone (516) 627-4800

1000 Montauk Hwy
West Islip, NY 11795
Phone (516) 705-2689

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: tzickerman23065@direct-chsli.net

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238716800000",
    "number": "1093840605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1048",
            "city": "PORT WASHINGTON",
            "state": "NY",
            "postal_code": "110501048",
            "telephone_number": "516-338-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PORT WASHINGTON BLVD",
            "city": "ROSLYN",
            "state": "NY",
            "postal_code": "115761353",
            "telephone_number": "516-338-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZICKERMAN",
        "first_name": "TARA",
        "middle_name": "LYNN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2009-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "006110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "CUNNINGHAM",
            "middle_name": "LYNN",
            "credential": "P.A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Roslyn, NY

Sources for this page

Verify at the official NPI Registry.