Individual provider Active NPI

Tasha R Cockrum, PA-C

  • Physician Assistant
  • Fresno, CA
National Provider Identifier
1689110066
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
56921 Issued in CA
Practice address
7585 N Cedar Ave Ste 102
Fresno, CA 93720-2763
Phone
(559) 243-1232
Fax
(559) 243-9954
NPI assigned
Jan 10, 2017
Last updated
Oct 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 56921 CA Primary

Addresses

Primary practice location

7585 N Cedar Ave Ste 102
Fresno, CA 93720-2763

Mailing address

PO Box 1023
Roseburg, OR 97470-0232
Phone (541) 440-6390

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20191017002283 CA Practitioner - Physician Assistant 2365773645 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MD Medical Group, Inc.Group PAC ID 8921997990, 2 clinicians

Practice addresses (Care Compare)

7585 N Cedar Ave
Suite 102
Fresno, CA 93720-2763
Phone (559) 243-1232

Merit-based Incentive Payment System (MIPS)

Final score
67.65 of 100Reported as individual
Quality
19.55
Improvement activities
40
Cost
78.03

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56921CAMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Valley Neurodiagnostic Medical Group, Inc. CurrentSince Oct 8, 2023 Accepting new patients
Umpqua Health - Harvard, LLC Past Accepting new patients

Locations

7585 N Cedar Ave
Ste 102
Fresno, CA 93720
Phone (559) 243-1232

Interoperability endpoints

  • Direct secure messaging: tcockrum3047953@direct.trinity-health.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1484006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1689110066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1023",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974700232",
            "telephone_number": "541-440-6390",
            "fax_number": "541-440-6392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7585 N CEDAR AVE STE 102",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937202763",
            "telephone_number": "559-243-1232",
            "fax_number": "559-243-9954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COCKRUM",
        "first_name": "TASHA",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-10",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "56921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.