Individual provider Active NPI

Tarrah O'Donnell, PA-C

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1114462728
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9110094 Issued in FL
Practice address
737 N Michigan Ave Ste 2270
Chicago, IL 60611-2680
Phone
(844) 432-1900
NPI assigned
Jan 5, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2020

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 9110094 FL Primary

Addresses

Primary practice location

737 N Michigan Ave Ste 2270
Chicago, IL 60611-2680

Mailing address

120 Sweetbriar BR
Longwood, FL 32750-2715
Phone (407) 923-5052

Other practice location 1

120 Sweetbriar Br
Longwood, FL 32750-2715
Phone (407) 923-5052

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170619002726 FL Practitioner - Physician Assistant 2365710191

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9110094FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ovation Hand Institute-Illinois, LTD Current Accepting new patients
Ovation Hand Institute, LLC CurrentSince Dec 6, 2020 Accepting new patients
Ovation Hand Institute-Wisconsin, SC. Current Accepting new patients
Florida Medical Associates LLC PastSince Apr 3, 2023 Accepting new patients
Ovation Hand Institute - FL P.a. PastSince Dec 15, 2024 Accepting new patients

Locations

737 N Michigan Ave
Ste 2270
Chicago, IL 60611
Phone (844) 432-1600

2593 Development Dr
Ste 270
Green Bay, WI 54311

10532 N Port Washington Rd
Ste 1A
Mequon, WI 53092
Phone (262) 240-9744

Interoperability endpoints

  • Direct secure messaging: tarrah.o.donnell.1@18732.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589241600000",
    "number": "1114462728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 SWEETBRIAR BR",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327502715",
            "telephone_number": "407-923-5052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 N MICHIGAN AVE STE 2270",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112680",
            "telephone_number": "844-432-1900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Sweetbriar Br",
            "address_purpose": "LOCATION",
            "city": "Longwood",
            "state": "FL",
            "postal_code": "327502715",
            "country_code": "US",
            "telephone_number": "407-923-5052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'DONNELL",
        "first_name": "TARRAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-05",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9110094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.