Individual provider Active NPI

Tara Nicole Havens, M.D.

  • Pediatric Pulmonology Physician
  • Ann Arbor, MI
National Provider Identifier
1235519539
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Pulmonology PhysicianTaxonomy code 2080P0214X
License
4301506708 Issued in MI
Practice address
1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Phone
(734) 936-4000
NPI assigned
Jun 2, 2015
Last updated
Feb 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 56195 AZ
Pediatrics Physician 208000000X 2019023014 MO
Pediatric Pulmonology Physician 2080P0214X 4301506708 MI Primary

Addresses

Primary practice location

1500 E Medical Center Dr
Ann Arbor, MI 48109-5000

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address thavens116591@direct.hurleymc.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220719002726 MI Practitioner - Pediatric MedicinePractitioner - Pulmonary Disease 4082969308 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
56195AZMDPediatrics Physician
2019023014MOMDPediatrics Physician
4301506708MIMDPediatric Pulmonology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan Pediatrics Current Accepting new patients
Regents of the University of Michigan Pediatrics CurrentSince Jul 12, 2022 Accepting new patients
Hurley Medical Center CurrentSince Apr 4, 2023 Accepting new patients
Hurley Medical Center Pediatrics CurrentSince Apr 4, 2023 Accepting new patients
Regents of the University of Michigan CurrentSince Jul 12, 2022 Accepting new patients
Hurley Medical Center Current Accepting new patients
Regents of the University of Michigan Past Accepting new patients

Locations

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

1125 S Linden Rd
Ste 100
Flint, MI 48532
Phone (810) 262-6555

300 E 1st St
#201
Flint, MI 48502
Phone (810) 262-9773

5710 Clio Rd
Flint, MI 48504
Phone (810) 785-4445

Interoperability endpoints

  • Direct secure messaging: thavens979451@direct.carenet.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1433203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1235519539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095000",
            "telephone_number": "734-936-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAVENS",
        "first_name": "TARA",
        "middle_name": "NICOLE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-02",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AZ",
            "license": "56195",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2019023014",
            "primary": false
        },
        {
            "code": "2080P0214X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Pulmonology",
            "state": "MI",
            "license": "4301506708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "thavens116591@direct.hurleymc.com",
            "affiliation": "N",
            "address_1": "300 E 1st St Ste 201",
            "city": "Flint",
            "state": "MI",
            "country_code": "US",
            "postal_code": "485021900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.