Individual provider Active NPI

Tara Vitale

  • Student in an Organized Health Care Education/Training Program
  • Middletown, NY
National Provider Identifier
1174298129
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
111 Maltese Dr
Middletown, NY 10940-2141
Phone
(845) 342-4774
NPI assigned
Aug 11, 2021
Last updated
May 28, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU Primary

Addresses

Primary practice location

111 Maltese Dr
Middletown, NY 10940-2141

Mailing address

111 Maltese Dr
Middletown, NY 10940-2141
Phone (845) 342-4774

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
I20240903002934 NY Practitioner - Nurse Practitioner 9032658182 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Middletown Medical PCGroup PAC ID 2567464308, 177 clinicians

Practice addresses (Care Compare)

111 Maltese Dr
Middletown, NY 10940-2115
Phone (845) 342-4774

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Middletown Medical PC CurrentSince Jun 17, 2024 Accepting new patients
Middletown Medical PC CurrentSince Jun 17, 2024 Accepting new patients
Binghamton University PastSince Aug 1, 2021 Accepting new patients
Binghamton University Health Services PastSince Aug 1, 2021 Accepting new patients

Locations

111 Maltese Dr
Middletown, NY 10940

Networks

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

Organizations & group practices 4

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 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": "1628640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1174298129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 MALTESE DR",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402141",
            "telephone_number": "845-342-4774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MALTESE DR",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402141",
            "telephone_number": "845-342-4774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITALE",
        "first_name": "TARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-11",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

Verify at the official NPI Registry.