Individual provider Active NPI

Tara McKittrick Braemer

  • Family Nurse Practitioner
  • Redding, CA
National Provider Identifier
1255877957
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP95005845 Issued in CA
Practice address
1441 Liberty St
Redding, CA 96001-0811
Phone
(530) 226-1726
NPI assigned
Jan 18, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP95005845 CA Primary

Addresses

Primary practice location

1441 Liberty St
Redding, CA 96001-0811

Mailing address

1441 Liberty St
Redding, CA 96001-0811
Phone (530) 226-1726

Other names 1

  • Tara McKittrick Braemer Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20170621002338 CA Practitioner - Nurse Practitioner 6002184785 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NP95005845CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Redding Rancheria CurrentSince Apr 15, 2017 Accepting new patients
Redding Rancheria CurrentSince Apr 15, 2017 Accepting new patients

Locations

3184 Churn Creek Rd
Redding, CA 96002
Phone (530) 224-2700

1441 Liberty St
Redding, CA 96001
Phone (530) 224-2700

4174 Ashby Ct
Shasta Lake, CA 96019
Phone (530) 224-2700

81 Arbuckle Ct
Weaverville, CA 96093
Phone (530) 623-0021

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1484697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488240000000",
    "number": "1255877957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 LIBERTY ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960010811",
            "telephone_number": "530-226-1726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 LIBERTY ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960010811",
            "telephone_number": "530-226-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAEMER",
        "first_name": "TARA",
        "middle_name": "MCKITTRICK",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-18",
        "last_updated": "2017-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95005845",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "BRAEMER",
            "middle_name": "MCKITTRICK",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.