Tara Mendozza Decrescentis, PA-C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2368 Issued in CO

Practice address

10099 Ridgegate Pkwy Ste 480
Lone Tree, CO 80124-5537

Phone

(720) 441-4021

Fax

(720) 360-1195

NPI assigned

Mar 24, 2007

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 identifiers 1

Other names 1

• Tara Mendozza Former name

Medicare fee-for-service enrollment

Enrolled in CO

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, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Spineone, PLLCGroup PAC ID 6406877521, 10 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Spineone, PLLC

  • Specialist
  • Lone Tree, CO
  • NPI 1760604409
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1174694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1407973266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 172263",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802172263",
            "telephone_number": "303-306-7783",
            "fax_number": "303-306-7753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10099 RIDGEGATE PKWY STE 480",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801245537",
            "telephone_number": "720-441-4021",
            "fax_number": "720-360-1195"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "499 E Hampden Ave Ste 360",
            "address_purpose": "LOCATION",
            "city": "Englewood",
            "state": "CO",
            "postal_code": "801133877",
            "country_code": "US",
            "telephone_number": "720-386-4508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DECRESCENTIS",
        "first_name": "TARA",
        "middle_name": "MENDOZZA",
        "credential": "PA-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "2368",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "2368",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "2368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "2368",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "MENDOZZA",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melanie Tolan Davis, OD
• Shaquille Davis
• Dawn M. Stanley, M. D., PC
• Adia De Los Santos
• Deanna Woodroffe LLC
• Katherine Marie Dederer, MD
• Elizabeth Degraw, RN
• Mariah Lynn Degusseme, FNP-C
• Heather Dekeyser
• Megan Elizabeth Dekok, DO, MSC

• Medical Physician Assistant in Lone Tree, CO
• Providers in Lone Tree, CO by specialty
• Medical Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.