Tara Marie Disalle, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2405 Issued in NV

Practice address

1691 W Horizon Ridge Pkwy
Suite 100
Henderson, NV 89012-3520

Phone

(702) 804-1212

Fax

(702) 804-1222

NPI assigned

Aug 1, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Tara Marie O'Toole Former name

Medicare fee-for-service enrollment

Enrolled in FL

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

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MD Now Medical Centers IncGroup PAC ID 3971554825, 314 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• MD Now Medical Centers Inc

  • Urgent Care Clinic/Center
  • West Palm Beach, FL
  • NPI 1033195474
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1396269312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1691 W HORIZON RIDGE PKWY",
            "address_2": "SUITE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890123520",
            "telephone_number": "702-804-1212",
            "fax_number": "702-804-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1691 W HORIZON RIDGE PKWY",
            "address_2": "SUITE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890123520",
            "telephone_number": "702-804-1212",
            "fax_number": "702-804-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISALLE",
        "first_name": "TARA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-01",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "50.005132RX",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.005132RX",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA2405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "O'TOOLE",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jocelyn Dip
• Theresa Dipreta
• Peter Diprete II, RD, RDN, LD
• Direct Compounding and Outsourcing
• Sophia Diri-Hunter
• S Richard Diskin, D.O.
• Katherine Disney-Fairchild
• Sarah Distad, DPT
• Dylan Ditzler
• Brenda Yavonne Dixon-Miller

• Physician Assistant in Henderson, NV
• Providers in Henderson, NV by specialty
• Physician Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; 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.