Individual provider Active NPI

Tara Roeder

  • Family Nurse Practitioner
  • Vancouver, WA
National Provider Identifier
1538708706
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
61027436 Issued in WA
Practice address
501 SE 172ND Ave
Vancouver, WA 98684-9542
Phone
(360) 882-2778
NPI assigned
Jan 5, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 61027436 WA Primary

Addresses

Primary practice location

501 SE 172ND Ave
Vancouver, WA 98684-9542

Mailing address

2808 P St
Vancouver, WA 98663-3136

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20200310001240 WA Practitioner - Nurse Practitioner 2860820693 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Vancouver Clinic Inc PSGroup PAC ID 3173436490, 580 clinicians

Practice addresses (Care Compare)

501 SE 172ND Ave
Vancouver, WA 98684-9542
Phone (360) 882-2778

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
61027436WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Vancouver Clinic Inc PS Current Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Aug 28, 2023 Accepting new patients
The Vancouver Clinic Inc PS CurrentSince Aug 28, 2023 Accepting new patients
The Vancouver Clinic Pharmacy Past Accepting new patients

Locations

700 NE 87th Ave
Vancouver, WA 98664
Phone (360) 397-1500

501 SE 172nd Ave
Vancouver, WA 98684

501 SE 172nd Ave
Ste 210
Vancouver, WA 98684

Interoperability endpoints

  • Direct secure messaging: troeder22381@tvc-direct.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1578182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1538708706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2808 P ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986633136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 SE 172ND AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986849542",
            "telephone_number": "360-882-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROEDER",
        "first_name": "TARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-05",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "61027436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.