Tamara Medina

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R189621 Issued in MD

Practice address

201 S Cleveland Ave
Hagerstown, MD 21740-5745

Phone

(301) 745-3777

NPI assigned

Oct 7, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Walnut Street Community Health Center, Inc.Group PAC ID 6305757402, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tamara.medina.1@30195.direct.athenahealth.com
• Direct secure messaging: tamara.medina.p1@direct.familyhch.nextgenshare.com

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.

• Walnut Street Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hagerstown, MD
  • NPI 1366425266
  Medicare reassignment Care Compare group NPD
• Well Mind Psychiatry LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Gaithersburg, MD
  • NPI 1982433363
  NPD Authorized official
• Walnut Street Community Health Center, Inc.

  dba Family Healthcare Pharmacy

  • Community/Retail Pharmacy
  • Hagerstown, MD
  • NPI 1871234294
  NPD

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

{
    "created_epoch": "1412640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1295138071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7055 SAMUEL MORSE DR",
            "address_2": "SUITE 200",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210463439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S CLEVELAND AVE",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405745",
            "telephone_number": "301-745-3777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "TAMARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-07",
        "last_updated": "2020-12-08",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R189621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Medical Practices of Antietam, LLC (Meritus Cosmetic and Plastic Surgery Center)
• Medical Practices of Antietam, LLC
• Medical Practices of Antietam, LLC
• Andrea M Medina, LMSW
• Dawn Tracey Medina, RPH
• Medoville Pharmacy Inc.
• Medstar Health Weight Management, LLC
• Medstar Health Weight Management, LLC
• Medstar Health Weight Management, LLC
• Medstar Medical Group II LLC

• Psychiatric/Mental Health Nurse Practitioner in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.