Tara T.S. Fagan, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4711 Issued in CT

Practice address

250 Flat Rock PL
Westbrook, CT 06498-1565

Phone

(860) 358-3760

NPI assigned

Aug 3, 2011

Last updated

Mar 2, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tara.fagan@chcict.eclinicaldirectplus.com
• Direct secure messaging: tfagan18713@middlesexhealthprd.direct-ci.com

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.

• MC Diagnostic of Connecticut, P.C.

  • Family Nurse Practitioner
  • Rocky Hill, CT
  • NPI 1386821932
  Medicare reassignment NPD

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

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488412800000",
    "number": "1114205473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 PARTRIDGE HOLLOW RD",
            "city": "KILLINGWORTH",
            "state": "CT",
            "postal_code": "064191025",
            "telephone_number": "860-452-4042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 FLAT ROCK PL",
            "city": "WESTBROOK",
            "state": "CT",
            "postal_code": "064981565",
            "telephone_number": "860-358-3760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "TARA",
        "middle_name": "T.S.",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-08-03",
        "last_updated": "2017-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "4711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Demartin, MSOM L.AC.
• Dignity Home Health LLC
• Patrick Duverger, LMSW
• Robin Ehle-Meyer, LMFT
• Serena Eldredge
• Melissa Febbroriello, L.C.S.W.
• Fernwood Holistic Health
• Kristin Kettering Foschi, LMFT
• Yizza Galdamez
• Alyssa Marie Gambardella, APRN

• Family Nurse Practitioner in Westbrook, CT
• Providers in Westbrook, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.