Individual provider Active NPI

Tabata Elizabeth Hernandez, MD

  • Internal Medicine Physician
  • Norwalk, CT
National Provider Identifier
1417688920
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
80802 Issued in CT
Practice address
120 Connecticut Ave
Norwalk, CT 06854-1525
Phone
(203) 851-1000
NPI assigned
Jun 23, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 80802 CT Primary

Addresses

Primary practice location

120 Connecticut Ave
Norwalk, CT 06854-1525

Mailing address

120 Connecticut Ave
Norwalk, CT 06854-1525
Phone (203) 851-1000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250606001378 CT Practitioner - Internal Medicine 3577073824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Norwalk Community Health Center IncGroup PAC ID 6305988510, 29 clinicians

Practice addresses (Care Compare)

120 Connecticut Ave
Norwalk, CT 06854-1525
Phone 20389917708005

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
80802CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Norwalk Community Health Center Inc CurrentSince Mar 24, 2025 Accepting new patients

Locations

120 Connecticut Ave
Norwalk, CT 06854
Phone (203) 851-1000

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CCDGCD
  • Direct secure messaging: tabata.hernandez.1@18107.direct.athenahealth.com

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1417688920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 CONNECTICUT AVE",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068541525",
            "telephone_number": "203-851-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 CONNECTICUT AVE",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068541525",
            "telephone_number": "203-851-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "TABATA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-23",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "80802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwalk, CT

Sources for this page

Verify at the official NPI Registry.