Individual provider Active NPI

Tabatha Poole, PA

  • Physician Assistant
  • Jamaica, NY
National Provider Identifier
1205104429
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
015365 Issued in NY
Practice address
8268 164TH St
Jamaica, NY 11432-1121
Phone
(718) 883-3000
NPI assigned
Dec 1, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

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 015365 NY Primary

Addresses

Primary practice location

8268 164TH St
Jamaica, NY 11432-1121

Mailing address

11576 225TH St
Cambria HTS, NY 11411-1235
Phone (718) 949-5184

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
I20120328000696 NY Practitioner - Physician Assistant 4486814431 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Samaritan Medical Services PCGroup PAC ID 7012016009, 341 clinicians
Community Medical Wellness PCGroup PAC ID 6709128697, 22 clinicians
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

100 Port Washington Blvd
Roslyn, NY 11576-1347
Phone (516) 325-7520

1000 Montauk Hwy
West Islip, NY 11795-4927
Phone (516) 705-2689

1050 Old Nichols Rd
FL 2
Islandia, NY 11749-5026
Phone (631) 828-4545

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

186 Joralemon St
Brooklyn, NY 11201-4356
Phone (212) 263-7300

Hospital & facility affiliations

  • St Francis Hospital - the Heart Center Hospital, Roslyn, NY, CCN 330182

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
015365NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Oct 6, 2025 Accepting new patients
New York University CurrentSince Oct 6, 2025 Accepting new patients

Locations

700 Hicksville Rd
Ste 205
Bethpage, NY 11714
Phone (646) 501-3325

186 Joralemon St
Brooklyn Heights, NY 11201
Phone (718) 852-1400

100 Port Washington Blvd
Roslyn, NY 11576
Phone (516) 562-6385

Networks

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

Interoperability endpoints

  • Direct secure messaging: tpoole751185@nyumc.direct-ci.com

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 and National Provider Directory roles.

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": "1322697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1205104429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11576 225TH ST",
            "city": "CAMBRIA HTS",
            "state": "NY",
            "postal_code": "114111235",
            "telephone_number": "718-949-5184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8268 164TH ST",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114321121",
            "telephone_number": "718-883-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "TABATHA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-01",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "015365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jamaica, NY

Sources for this page

Verify at the official NPI Registry.