Tate Coltan Staker, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1932 Issued in ID

Practice address

130 W Main St
Rexburg, ID 83440-1827

Phone

(208) 356-8818

NPI assigned

Apr 7, 2020

Last updated

Oct 28, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Medicare reassignment Care Compare group NPD
• CC Pocatello LLC

  dba Community Care Pocatello

  • Family Medicine Physician
  • Pocatello, ID
  • NPI 1538517156
  Medicare reassignment
• Community Care West Side LLC

  • Family Medicine Physician
  • Idaho Falls, ID
  • NPI 1295009785
  Medicare reassignment
• Community Care

  • Family Medicine Physician
  • Idaho Falls, ID
  • NPI 1790708832
  NPD
• Community Care Pocatello PLLC

  • Urgent Care Clinic/Center
  • Pocatello, ID
  • NPI 1265714760
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Care Compare affiliation

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1184253585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 W MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401827",
            "telephone_number": "208-356-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W MAIN ST",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401827",
            "telephone_number": "208-356-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAKER",
        "first_name": "TATE",
        "middle_name": "COLTAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-07",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1932",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southpoint Family and Urgent Care PLLC
• Emily Spackman, D.P.T
• Rodney Lee Sparks, BSW
• Spine and Sport Pysical Therapy PC
• Dustin Boyd Stacey, PHARMD
• Cameron Stephenson, NP
• Elizabeth Clark Stephenson, LCPC
• Steps Inc.
• Sterling Provider Group
• Dallas Stevens

• Physician Assistant in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.