Individual provider Active NPI

Lara Mitchell Tate, P.A.-C

  • Medical Physician Assistant
  • Indianapolis, IN
National Provider Identifier
1649412560
Registry record updated Nov 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
10001051 Issued in IN
Practice address
8402 Harcourt Rd Ste 120
Indianapolis, IN 46260-2006
Phone
(317) 338-4303
NPI assigned
Mar 25, 2009
Last updated
Nov 30, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 10001051 IN Primary

Addresses

Primary practice location

8402 Harcourt Rd Ste 120
Indianapolis, IN 46260-2006

Mailing address

8402 Harcourt Rd Ste 120
Indianapolis, IN 46260-2006

Other practice location 1

11700 N Meridian St
Carmel, IN 46032-4656
Phone (317) 688-3140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Barry University School of Podiatric Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12901 Bruce B Downs Blvd
Suite 62
Tampa, FL 33612-4799

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10001051INMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa General Hospital Current Accepting new patients
University Medical Diagnostic Associates, Inc. Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: lara.tate.1@7598.direct.athenahealth.com
  • Direct secure messaging: ltate279889@direct.tgh.org

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.

Hospital & facility affiliations 1

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": "1237939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701302400000",
    "number": "1649412560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8402 HARCOURT RD STE 120",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8402 HARCOURT RD STE 120",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602006",
            "telephone_number": "317-338-4303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11700 N Meridian St",
            "address_purpose": "LOCATION",
            "city": "Carmel",
            "state": "IN",
            "postal_code": "460324656",
            "country_code": "US",
            "telephone_number": "317-688-3140",
            "fax_number": "317-688-2664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TATE",
        "first_name": "LARA",
        "middle_name": "MITCHELL",
        "name_prefix": "Mrs.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-25",
        "last_updated": "2023-11-30",
        "certification_date": "2023-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10001051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.