Individual provider Active NPI

Tara Hyneman

  • Family Nurse Practitioner
  • Gouverneur, NY
National Provider Identifier
1518857440
Registry record updated Jul 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
357031 Issued in NY
Practice address
77 W Barney St
Gouverneur, NY 13642-1040
Phone
(315) 287-1000
NPI assigned
Jul 3, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 357031 NY
Family Nurse Practitioner 363LF0000X 357031 NY Primary

Addresses

Primary practice location

77 W Barney St
Gouverneur, NY 13642-1040

Mailing address

50 Leroy St
Potsdam, NY 13676-1786

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20250915002485 NY Practitioner - Nurse Practitioner 0749783686 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Canton-Potsdam HospitalGroup PAC ID 6204827280, 243 clinicians

Practice addresses (Care Compare)

201 Market St
Suite E
Potsdam, NY 13676-1218
Phone (315) 274-9102

77 W Barney St
CPH Specialty Suites at GVNR
Governed, NY 13642-1040
Phone (315) 287-1000

80 E Main St
Canton, NY 13617-1450
Phone (315) 386-3300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Canton-Potsdam Hospital CurrentSince Aug 4, 2025 Accepting new patients
Canton-Potsdam Hospital CurrentSince Aug 4, 2025 Accepting new patients
Canton Potsdam Hospital Past Accepting new patients

Locations

80 E Main St
Canton, NY 13617
Phone (315) 261-6034

77 W Barney St
Gouverneur, NY 13642
Phone (315) 287-1000

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102

Interoperability endpoints

  • Direct secure messaging: thyneman337832@direct.rochesterregional.org

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 2

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": "1751500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751500800000",
    "number": "1518857440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 LEROY ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 W BARNEY ST",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421040",
            "telephone_number": "315-287-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HYNEMAN",
        "first_name": "TARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-03",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "NY",
            "license": "357031",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "357031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gouverneur, NY

Sources for this page

Verify at the official NPI Registry.