Tammera L Park, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10004691A Issued in IN

Practice address

1641 S US Highway 231
Crawfordsville, IN 47933-9421

Phone

(765) 307-7146

Fax

(833) 464-2510

NPI assigned

Oct 10, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Tammera L Park Professional name

Medicare fee-for-service enrollment

Enrolled in CO, NC, IN3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tammerapark@imhi.allscriptsdirect.net

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.

• Access Medical Clinic LLC

  • Rural Health Clinic/Center
  • Crawfordsville, IN
  • NPI 1831810431

  Family Medicine

  Medicare reassignment NPD
• Firstdoc PC

  • Internal Medicine Physician
  • Denver, CO
  • NPI 1497076681
  Medicare reassignment
• Promed Healthcare, PLLC

  • Family Medicine Physician
  • Charlotte, NC
  • NPI 1770615114
  Medicare reassignment
• Access Medical Clinic LLC

  • Rural Health Clinic/Center
  • Jacksboro, TN
  • NPI 1114881117

  Family Medicine

  NPD
• Provident Senior Health, Inc.

  • Internal Medicine Physician
  • Englewood, CO
  • NPI 1780640169
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735516800000",
    "number": "1598853129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4196 HIGHWAY 62 412 STE A",
            "city": "HARDY",
            "state": "AR",
            "postal_code": "725428002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641 S US HIGHWAY 231",
            "city": "CRAWFORDSVILLE",
            "state": "IN",
            "postal_code": "479339421",
            "telephone_number": "765-307-7146",
            "fax_number": "833-464-2510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1690 Meade St",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802041552",
            "country_code": "US",
            "telephone_number": "970-439-2313",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "PO Box 479",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "CO",
            "postal_code": "805160479",
            "country_code": "US",
            "telephone_number": "704-637-8040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARK",
        "first_name": "TAMMERA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "2054",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10004691A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04020954",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "261227YLQP",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAMMERA",
            "last_name": "PARK",
            "middle_name": "L",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Lorna J O'Connell, MS, RDN, CD
• Alexandria Odum, RBT
• Kayla Ogden, NP
• Montana Elaine Ogden, PHARMD
• Olumide Emmanuel Oluwarotimi
• Madeline Parker
• Connor Parsell
• Falguni A Patel
• Pravin M Patel, MD
• Robert D Patterson, M.D.

• Physician Assistant in Crawfordsville, IN
• Providers in Crawfordsville, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.