Individual provider Active NPI

Robin Renae Tudor, MMS, PA-C

  • Physician Assistant
  • Valparaiso, IN
National Provider Identifier
1285884817
Registry record updated Sep 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10001201A Issued in IN
Practice address
85 E US Highway 6 Ste 310
Valparaiso, IN 46383
Phone
(219) 983-6380
Fax
(219) 983-6080
NPI assigned
Sep 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2020

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 10001201A IN Primary

Addresses

Primary practice location

85 E US Highway 6 Ste 310
Valparaiso, IN 46383

Mailing address

2022 Kelle Dr
Chesterton, IN 46304-8708
Phone (219) 364-3616

Other identifiers 1

IdentifierTypeStateIssuer
1084333OtherINNCCPA

Other names 1

  • Robin Renae Smolak Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address robin.tudor.1@2340.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20141103000679 IN Practitioner - Physician Assistant 0749343283 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Porter Physician Services LLCGroup PAC ID 1850482407, 96 clinicians

Practice addresses (Care Compare)

650 Dickinson Rd
Chesterton, IN 46304-3387

Hospital & facility affiliations

  • Northwest Health - Porter Hospital, Valparaiso, IN, CCN 150035

Merit-based Incentive Payment System (MIPS)

Final score
90.68 of 100Reported as apm
Quality
76.2
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Porter Physician Services LLC Past Accepting new patients

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.

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": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600387200000",
    "number": "1285884817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2022 KELLE DR",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463048708",
            "telephone_number": "219-364-3616",
            "fax_number": "219-364-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 E US HIGHWAY 6 STE 310",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "46383",
            "telephone_number": "219-983-6380",
            "fax_number": "219-983-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUDOR",
        "first_name": "ROBIN",
        "middle_name": "RENAE",
        "name_prefix": "Ms.",
        "credential": "MMS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-18",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10001201A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1084333",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "robin.tudor.1@2340.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "85 E US Highway 6 Ste 310",
            "city": "Valparaiso",
            "state": "IN",
            "country_code": "US",
            "postal_code": "46383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ROBIN",
            "last_name": "SMOLAK",
            "middle_name": "RENAE",
            "credential": "MMS, PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Valparaiso, IN

Sources for this page

Verify at the official NPI Registry.