Individual provider Active NPI

Tara Schram

  • Dentist
  • Abingdon, VA
National Provider Identifier
1366012676
Registry record updated Jun 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401417508 Issued in VA
Practice address
616 Campus Dr Ste 100
Abingdon, VA 24210-9706
Phone
(276) 525-4487
NPI assigned
Jun 29, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401417508 VA Primary

Addresses

Primary practice location

616 Campus Dr Ste 100
Abingdon, VA 24210-9706

Mailing address

616 Campus Dr Ste 100
Abingdon, VA 24210-9706

Other practice location 1

616 Campus Dr Ste 100
Abingdon, VA 24210-9706
Phone (276) 525-4487

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0401417508VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Mission Dental Virginia, Inc CurrentSince Jul 4, 2021 Accepting new patients

Locations

616 Campus Dr
Ste 100
Abingdon, VA 24210
Phone (276) 525-4487

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.

NPI Registry JSON

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

{
    "created_epoch": "1624924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1366012676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 CAMPUS DR STE 100",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242109706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 CAMPUS DR STE 100",
            "city": "ABINGDON",
            "state": "VA",
            "postal_code": "242109706",
            "telephone_number": "276-525-4487"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "616 Campus Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242109706",
            "country_code": "US",
            "telephone_number": "276-525-4487",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCHRAM",
        "first_name": "TARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-29",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401417508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Abingdon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.