Individual provider Active NPI

Nicholas John Tarnowski, PA

  • Physician Assistant
  • Johnson City, NY
National Provider Identifier
1104179530
Registry record updated Dec 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
016143 Issued in NY
Practice address
33-57 Harrison St
Johnson City, NY 13790-2107
Phone
(607) 763-6412
Fax
(607) 763-5854
NPI assigned
Oct 23, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2013

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 016143 NY Primary

Addresses

Primary practice location

33-57 Harrison St
Johnson City, NY 13790-2107

Mailing address

346 Grand Ave
Johnson City, NY 13790-2580
Phone (607) 729-8156

Other identifiers 1

IdentifierTypeStateIssuer
03521386MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160915000630 MO Practitioner - Physician Assistant 7416100185 Reassigns benefits to 1 organization
I20170316002550 KS Practitioner - Physician Assistant 7416100185 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kansas University Physicians IncGroup PAC ID 8921911587, 1,809 clinicians

Practice addresses (Care Compare)

10710 Nall Ave
Overland Park, KS 66211-1206
Phone (913) 588-1227

10720 Nall Ave
Overland Park, KS 66211-1206

10777 Nall Ave
Psych
Overland Park, KS 66211-1362
Phone (913) 588-1227

10790 Nall Ave
Overland Park, KS 66211-1206
Phone (913) 588-1227

12000 W 151St St
Olathe, KS 66062-7200
Phone (913) 588-1227

3901 Rainbow Blvd
Kansas City, KS 66160-7330
Phone (913) 588-6144

3901 Rainbow Blvd
Kansas City, KS 66160-8500
Phone (913) 588-7013

4000 Cambridge St
Kansas City, KS 66160-8500

4000 Cambridge St
Suite G600
Kansas City, KS 66160-8501
Phone (913) 588-1227

Hospital & facility affiliations

  • University of Kansas Hospital Hospital, Kansas City, KS, CCN 170040

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
016143NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Kansas Hospital Authority CurrentSince Dec 11, 2018 Accepting new patients
Kansas University Physicians Inc CurrentSince Jan 19, 2022 Accepting new patients
University of Kansas Hospital Authority CurrentSince Dec 11, 2018 Accepting new patients
Kansas University Physicians Inc Past Accepting new patients

Locations

2000 Olathe
Kansas City, KS 66160
Phone (913) 588-1908

3901 Rainbow Blvd
Kansas City, KS 66160
Phone (913) 588-6005

11300 Corporate Ave
Ste 342
Lenexa, KS 66219
Phone (913) 574-0425

20333 W 151st St
Olathe, KS 66061
Phone (888) 960-1393

12000 W 151st St
Olathe, KS 66062
Phone (913) 588-2000

10730 Nall Ave
Ste 201
Overland Park, KS 66211
Phone (913) 945-7000

10730 Nall Ave
Ste 101
Overland Park, KS 66211
Phone (713) 754-2800

10730 Nall Ave
Ste 200
Overland Park, KS 66211
Phone (913) 574-1460

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.

Hospital & facility affiliations 2

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": "1350950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387756800000",
    "number": "1104179530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "346 GRAND AVE",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902580",
            "telephone_number": "607-729-8156",
            "fax_number": "607-729-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33-57 HARRISON ST",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902107",
            "telephone_number": "607-763-6412",
            "fax_number": "607-763-5854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARNOWSKI",
        "first_name": "NICHOLAS",
        "middle_name": "JOHN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-23",
        "last_updated": "2013-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "016143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03521386",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, NY

Sources for this page

Verify at the official NPI Registry.