Tara J Belsare, MD

Key facts

NPI

1245355155

Entity type

Individual (NPI type 1)

Primary specialty

Psychiatry Physician 2084P0800X

License

223656 (NY)

Practice address

3220 Pearl St
Endwell, NY 13760-5758

Phone

(607) 215-1705

Fax

(607) 304-2374

NPI assigned

Mar 20, 2007

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

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.

• Tioga County Clinical Social Worker · Owego, NY · NPI 1124099700
  NPD (past) PSYCHIATRY

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Opted out of Medicare

Yes, effective Oct 17, 2024 through Oct 17, 2026

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: tbelsare@hiemail.healtheconnections.org

Specialties & licenses

Addresses

Other identifiers

Other names

• Shubhada Jayant Belsare Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 6, 2024.

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1245355155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 CRARY AVE",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139053829",
            "telephone_number": "607-624-1775",
            "fax_number": "607-203-1668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 PEARL ST",
            "city": "ENDWELL",
            "state": "NY",
            "postal_code": "137605758",
            "telephone_number": "607-215-1705",
            "fax_number": "607-304-2374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELSARE",
        "first_name": "TARA",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-20",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "223656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "223656",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHUBHADA",
            "last_name": "BELSARE",
            "middle_name": "JAYANT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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All providers in Endwell, NY · Psychiatry Physician in New York