Individual provider Active NPI

Tabatha O Hallman, LCSW

  • Social Worker
  • Elizabethton, TN
National Provider Identifier
1508119843
Registry record updated Jun 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
5956 Issued in TN
Practice address
426 East G Street
Elizabethton, TN 37643
Phone
(423) 547-5950
Fax
(423) 467-3644
NPI assigned
Oct 24, 2012
Last updated
Jun 23, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 5956 TN Primary
Clinical Social Worker 1041C0700X 9274 SC

Addresses

Primary practice location

426 East G Street
Elizabethton, TN 37643

Mailing address

1167 Spratlin Park Drive
Pob 9054
Gray, TN 37615-9054
Phone (423) 467-3600

Other names 1

  • Ms. Tabatha Overstreet Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140819002203 TN Practitioner - Clinical Psychologist 8628295417 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Tulane University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Frontier HealthGroup PAC ID 2860302320, 70 clinicians

Practice addresses (Care Compare)

1167 Spratlin Park Dr
Gray, TN 37615-6205
Phone (423) 467-3600

426 E G St
Elizabethton, TN 37643-3224
Phone (423) 467-3600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9274SCMDClinical Social Worker
5956TNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Frontier Health CurrentSince May 19, 2014 Accepting new patients
Frontier Health CurrentSince May 19, 2014 Accepting new patients

Locations

426 E G St
Elizabethton, TN 37643
Phone (423) 547-5950

1167 Spratlin Park Dr
Johnson City, TN 37615
Phone (423) 232-2670

607 Baxter St
Johnson City, TN 37601
Phone (423) 232-2670

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1508119843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1167 SPRATLIN PARK DRIVE",
            "address_2": "POB 9054",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376159054",
            "telephone_number": "423-467-3600",
            "fax_number": "423-467-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "426 EAST G STREET",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "37643",
            "telephone_number": "423-547-5950",
            "fax_number": "423-467-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLMAN",
        "first_name": "TABATHA",
        "middle_name": "O",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-24",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TN",
            "license": "5956",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "9274",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TABATHA",
            "last_name": "OVERSTREET",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Elizabethton, TN

Sources for this page

Verify at the official NPI Registry.