Tamara A. Pride, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085001795 Issued in IL

Practice address

820 E Terra Cotta Ave Ste 125
Crystal Lake, IL 60014

Phone

(815) 455-4434

Fax

(815) 455-4593

NPI assigned

Apr 12, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Physician Assistant

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Suleman J. Bangash D.O.S.C.Group PAC ID 8729165006, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24526/brand/1/csg/1/fhir/r4

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.

• Suleman J. Bangash D.O.S.C.

  • MOHS-Micrographic Surgery Physician
  • Elgin, IL
  • NPI 1841469830
  Medicare reassignment Care Compare group
• Dermatology Physicians & Surgeons, LTD

  dba Van Dam Dermatology

  • Dermatology Physician
  • Barrington, IL
  • NPI 1932271210
  NPD
• Mohs Surgery &Dermatology

  • Specialist
  • Elgin, IL
  • NPI 1356721591
  NPD (past)

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527120000000",
    "number": "1649494691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE",
            "address_2": "STE 125",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600143650",
            "telephone_number": "847-842-8839",
            "fax_number": "847-392-8439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E TERRA COTTA AVE STE 125",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60014",
            "telephone_number": "815-455-4434",
            "fax_number": "815-455-4593"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 W Central Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Arlington Heights",
            "state": "IL",
            "postal_code": "600052465",
            "country_code": "US",
            "telephone_number": "847-392-5440",
            "fax_number": "847-392-8439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRIDE",
        "first_name": "TAMARA",
        "middle_name": "A.",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2018-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085001795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Wellness Chiropracitc, Inc.
• Reagan Janet Prestley
• Nathan Price
• Sara Lahey Price, L.C.S.W.
• Stacey A Price, LCSW
• Prism Health PLLC
• Procare Dental Group, P.C. (LakeHills Dentistry)
• Susan Proebsting, LCPC
• Nancy Renee Prokup, CNP
• Colleen Prosek

• Physician Assistant in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.