Mark Tabaka, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1803 Issued in CT

Practice address

576 Farmington Ave
Bristol, CT 06010-3933

Phone

(860) 585-3000

NPI assigned

Aug 12, 2005

Last updated

Nov 5, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Yale UniversityGroup PAC ID 9436061736, 2,632 clinicians

Urgent Care Medical Associates, LLCGroup PAC ID 7214107515, 113 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Yale-New Haven Hospital Hospital, New Haven, CT, CCN 070022

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mtabaka418834@direct.ynhh.org
• Direct secure messaging: mtabaka506952@xdr.hhchealthdirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Yale University

  dba Yale Medicine

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236
  Medicare reassignment Care Compare group NPD
• Urgent Care Medical Associates, LLC

  • Urgent Care Clinic/Center
  • Brookfield, CT
  • NPI 1730479254
  Medicare reassignment Care Compare group
• Midstate Medical Center

  • General Acute Care Hospital
  • Meriden, CT
  • NPI 1154425288
  Medicare reassignment
• Prospect CT Medical Foundation, Inc.

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1144677568
  Medicare reassignment
• Midstate Medical Center

  • Psychiatric Hospital Unit
  • Meriden, CT
  • NPI 1316022718
  NPD
• Midstate Medical Center

  • General Acute Care Hospital
  • Meriden, CT
  • NPI 1427007848
  NPD
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962
  NPD
• Eastern Connecticut Medical Professionals Foundation, Inc

  dba Eastern Orthopeadics and Sports Medicine, PC

  • Specialist
  • South Windsor, CT
  • NPI 1497864516
  NPD (past)
• Waterbury Hospital

  • General Acute Care Hospital
  • Waterbury, CT
  • NPI 1184615114
  NPD (past)
• WRK Ventures, LLC

  dba Urgent Care of Southbury

  • Urgent Care Clinic/Center
  • Southbury, CT
  • NPI 1194993980
  NPD (past)

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

• Yale New Haven Hospital

  • General Acute Care Hospital
  • New Haven, CT
  • NPI 1336139500
  Care Compare affiliation
• Yale New Haven Hospital

  • General Acute Care Hospital
  • New Haven, CT
  • NPI 1578778726
  Care Compare affiliation

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541376000000",
    "number": "1457353005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 ARKONA DR",
            "city": "HIGGANUM",
            "state": "CT",
            "postal_code": "064414479",
            "telephone_number": "860-554-5021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 FARMINGTON AVE",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060103933",
            "telephone_number": "860-585-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABAKA",
        "first_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2018-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "1803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robin Suplinskas, RN
• Surgical Associates of Bristol PC
• Geetha Rani Swamy Iyah, MD
• Chelsea Swanson, MS, CCC-SLP
• Megan Swenton
• Christopher Tagliavini, PA-C
• Shannon Lynn Talbot, LMFT
• Marissa Jean Tanasi, APRN
• James T Tanski, RPH
• Mythili Tarala

• Medical Physician Assistant in Bristol, CT
• Providers in Bristol, CT by specialty
• Medical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.