NPIMap

Individual provider Active NPI

Rebekah June Tisdale, FNP-BC

  • Family Nurse Practitioner
  • Waddington, NY
National Provider Identifier
1295566388
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
354223 Issued in NY
Practice address
4 Montgomery Heights
Waddington, NY 13694
Phone
(315) 388-7872
Fax
(315) 388-4311
NPI assigned
Aug 9, 2024
Sex
Female
Sole proprietor
Yes

Organizations & group practices 18

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.

View all 18

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Claxton-Hepburn Medical Center 78 clinicians
Carthage Area Hospital Inc 119 clinicians

Practice addresses (Care Compare)

4 Montgomery HTS
Waddington, NY 13694-7712
Phone (315) 388-7872

Hospital & facility affiliations

  • Carthage Area Hospital, Inc Hospital, Ogdensburg, NY, CCN 331324
  • Carthage Area Hospital, Inc Hospital, Carthage, NY, CCN 331318
  • Canton-Potsdam Hospital Hospital, Potsdam, NY, CCN 330197
  • SLHS Massena, Inc Hospital, Massena, NY, CCN 331322

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20250207001305 NY Practitioner - Nurse Practitioner 9335679265 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
354223NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carthage Area Hospital Inc Current Accepting new patients
Carthage Area Hospital Inc CurrentSince Dec 1, 2024 Accepting new patients
Carthage Area Hospital, Inc. CurrentSince Dec 1, 2024 Accepting new patients
Carthage Area Hospital Inc. Past Accepting new patients

Locations

1001 West St
Carthage, NY 13619
Phone (315) 493-1000

Interoperability endpoints

  • Direct secure messaging: rtisdale@cahclinics.medentdirect.com

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 354223 NY Primary

Addresses

NPPES NPI Registry

Primary practice location

4 Montgomery Heights
Waddington, NY 13694

Mailing address

4 Montgomery Heights
Waddington, NY 13694
Phone (315) 388-7872

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 27, 2024.

{
    "created_epoch": "1723161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1295566388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MONTGOMERY HEIGHTS",
            "city": "WADDINGTON",
            "state": "NY",
            "postal_code": "13694",
            "telephone_number": "315-388-7872",
            "fax_number": "315-388-4311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MONTGOMERY HEIGHTS",
            "city": "WADDINGTON",
            "state": "NY",
            "postal_code": "13694",
            "telephone_number": "315-388-7872",
            "fax_number": "315-388-4311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "REBEKAH",
        "middle_name": "JUNE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-09",
        "last_updated": "2024-11-27",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "354223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waddington, NY

Sources for this page

Verify at the official NPI Registry.