Individual provider Active NPI

Tara Denise Frazier, NP

  • Gerontology Nurse Practitioner
  • El Segundo, CA
National Provider Identifier
1659926384
Registry record updated Aug 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
95012377 Issued in CA
Practice address
222 N Pacific Coast Hwy Ste 2175
El Segundo, CA 90245-5639
Phone
(877) 878-3289
Fax
(424) 217-1826
NPI assigned
Aug 8, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 95012377 CA Primary

Addresses

Primary practice location

222 N Pacific Coast Hwy Ste 2175
El Segundo, CA 90245-5639

Mailing address

222 N Pacific Coast Hwy Ste 2175
El Segundo, CA 90245-5639
Phone (877) 878-3289

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, CA, UT, NM4 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 4

Enrollment IDStateProvider typePAC IDDetails
I20191106000145 CO Practitioner - Nurse Practitioner 1456683796 Reassigns benefits to 1 organization
I20191119000529 CA Practitioner - Nurse Practitioner 1456683796 Reassigns benefits to 2 organizations
I20200521002389 UT Practitioner - Nurse Practitioner 1456683796
I20231221001000 NM Practitioner - Nurse Practitioner 1456683796 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
Robert Marriott Medical CorpGroup PAC ID 2567531494, 63 clinicians

Practice addresses (Care Compare)

900 Mountain Ranch Rd
San Andreas, CA 95249-9713
Phone (209) 754-3823

930 W Main St
Ripon, CA 95366-2325
Phone (209) 599-4221

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baromedical Physician Associates Medical Group CurrentSince Mar 1, 2020 Accepting new patients

Locations

222 N Pacific Coast Hwy
Ste 2175
El Segundo, CA 90245
Phone (877) 850-8762

5750 Downey Ave
Ste 100
Lakewood, CA 90712
Phone (562) 630-3105

720 N Tustin Ave
Ste 100
Santa Ana, CA 92705
Phone (714) 973-8777

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1565222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565222400000",
    "number": "1659926384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 N PACIFIC COAST HWY STE 2175",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902455639",
            "telephone_number": "877-878-3289",
            "fax_number": "424-217-1826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 N PACIFIC COAST HWY STE 2175",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902455639",
            "telephone_number": "877-878-3289",
            "fax_number": "424-217-1826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRAZIER",
        "first_name": "TARA",
        "middle_name": "DENISE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-08",
        "last_updated": "2019-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95012377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Segundo, CA

Sources for this page

Verify at the official NPI Registry.