NPIMap

Individual provider Active NPI

Tianita Deshea Alexander, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Redding, CA
National Provider Identifier
1174051775
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA54578 Issued in CA
Practice address
1742 Oregon Street
Redding, CA 96001
Phone
(530) 646-7269
Fax
(530) 737-7681
NPI assigned
May 25, 2017
Last updated
Sep 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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 PA54578 CA Primary

Addresses

Primary practice location

1742 Oregon Street
Redding, CA 96001

Mailing address

2865 Churn Creek Rd Ste a
Redding, CA 96002-1117

Other names 1

  • Tianita Deshea Duke Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171018000118 TX Practitioner - Physician Assistant 7113291576
I20200813000817 CA Practitioner - Physician Assistant 7113291576 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
County of InyoGroup PAC ID 1052457561, 4 clinicians
Native American Mental Health Services CorporationGroup PAC ID 5395072490, 62 clinicians

Practice addresses (Care Compare)

1360 N Main St
Bishop, CA 93514-3013

1742 Oregon St
Redding, CA 96001-1717
Phone (530) 646-7269

PO Box H
Independence, CA 93526

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54578CAMDOral and Maxillofacial Surgery (Dentist)
PA54578CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Rural Health Clinics CurrentSince Jun 18, 2020 Accepting new patients
County of Inyo CurrentSince Sep 1, 2024 Accepting new patients
Rolling Hills Clinic Past Accepting new patients

Locations

1360 N Main St
Ste 124
Bishop, CA 93514
Phone (760) 872-2590

1850 Spring Ridge Dr
Susanville, CA 96130
Phone (530) 251-5000

Interoperability endpoints

  • Direct secure messaging: tianita.alexander.1@15156.direct.athenahealth.com
  • Direct secure messaging: tianita.alexander.p1@direct.lcthc.nextgenshare.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1495670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1174051775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2865 CHURN CREEK RD STE A",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960021117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1742 OREGON STREET",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "96001",
            "telephone_number": "530-646-7269",
            "fax_number": "530-737-7681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALEXANDER",
        "first_name": "TIANITA",
        "middle_name": "DESHEA",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-25",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA54578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIANITA",
            "last_name": "DUKE",
            "middle_name": "DESHEA",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.