Individual provider Active NPI

Tia Dawes, PA-C

  • Physician Assistant
  • State College, PA
National Provider Identifier
1487061305
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA056979 Issued in PA
Practice address
1850 E Park Ave
Ste 302
State College, PA 16803-6706
Phone
(814) 278-4680
Fax
(814) 235-1523
NPI assigned
Jul 14, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA056979 PA Primary

Addresses

Primary practice location

1850 E Park Ave
Ste 302
State College, PA 16803-6706

Mailing address

1850 E Park Ave
Ste 302
State College, PA 16803-6706
Phone (814) 278-4680

Other names 1

  • Tia Dudukovich Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20160125000266 PA Practitioner - Physician Assistant 4082917182 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Practice addresses (Care Compare)

129 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-3626

141 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-7322

143 Hospital Dr
State College, PA 16803-5500
Phone (814) 237-3470

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mount Nittany Medical Center Health Services Inc CurrentSince Jul 11, 2016 Accepting new patients
Pinecroft Medical Center Past Accepting new patients
Mount Nittany Medical Center Health Services Inc Past Accepting new patients

Locations

417 Sabbath Rest Rd
Ste 3
Altoona, PA 16601
Phone (814) 940-8195

141 Medical Park Ln
Bellefonte, PA 16823
Phone (814) 355-7322

143 Hospital Dr
Ste 302
State College, PA 16803
Phone (814) 278-4680

1850 E Park Ave
Ste 201
State College, PA 16803
Phone (814) 234-8800

Organizations & group practices 3

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 5

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": "1405296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1487061305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 E PARK AVE",
            "address_2": "STE 302",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036706",
            "telephone_number": "814-278-4680",
            "fax_number": "814-235-1523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 E PARK AVE",
            "address_2": "STE 302",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036706",
            "telephone_number": "814-278-4680",
            "fax_number": "814-235-1523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAWES",
        "first_name": "TIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-14",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA056979",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIA",
            "last_name": "DUDUKOVICH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.