Individual provider Active NPI

Shelly Tat, DO

  • Family Medicine Physician
  • Highland Heights, KY
National Provider Identifier
1699335067
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
05196 Issued in KY
Practice address
2626 Alexandria Pike
Highland Heights, KY 41076-1530
Phone
(859) 781-4111
Fax
(859) 441-5214
NPI assigned
Jun 18, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromusculoskeletal Medicine & OMM Physician 204D00000X 05196 KY
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 05196 KY Primary

Addresses

Primary practice location

2626 Alexandria Pike
Highland Heights, KY 41076-1530

Mailing address

2626 Alexandria Pike
Highland Heights, KY 41076-1530
Phone (859) 781-4111

Other practice location 1

413 S Loop Rd
Edgewood, KY 41017-5446
Phone (859) 301-3800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230908000545 KY Practitioner - Family PracticePractitioner - Other (Physician) 2062876113 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still Un of HLTH Sciences, Col of Osteo Med, Mesa, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Medical Group IncGroup PAC ID 2163326240, 803 clinicians
Oxford Physical Therapy and RehabilitationGroup PAC ID 0244232874, 432 clinicians

Practice addresses (Care Compare)

2626 Alexandria Pike
Highland Heights, KY 41076-1530
Phone (859) 757-0434

580 Buttermilk Pike
Crescent Springs, KY 41017-1635
Phone (859) 341-6654

7567 Central Parke Blvd
A
Mason, OH 45040-6852

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc. CurrentSince Aug 28, 2023 Accepting new patients
Summit Medical Group, Inc. Family Medicine CurrentSince Aug 28, 2023 Accepting new patients
Summit Medical Group, Inc Family Medicine Current Accepting new patients

Locations

1980 Litton Ln
Hebron, KY 41048
Phone (859) 334-8700

2626 Alexandria Pike
Highland Heights, KY 41076
Phone (859) 757-0434

1400 Grand Ave
Newport, KY 41071
Phone (859) 905-3070

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Interoperability endpoints

  • Direct secure messaging: stat404646@direct-prd.stelizabeth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1699335067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 ALEXANDRIA PIKE",
            "city": "HIGHLAND HEIGHTS",
            "state": "KY",
            "postal_code": "410761530",
            "telephone_number": "859-781-4111",
            "fax_number": "859-441-5214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 ALEXANDRIA PIKE",
            "city": "HIGHLAND HEIGHTS",
            "state": "KY",
            "postal_code": "410761530",
            "telephone_number": "859-781-4111",
            "fax_number": "859-441-5214"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "413 S Loop Rd",
            "address_purpose": "LOCATION",
            "city": "Edgewood",
            "state": "KY",
            "postal_code": "410175446",
            "country_code": "US",
            "telephone_number": "859-301-3800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAT",
        "first_name": "SHELLY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-18",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "KY",
            "license": "05196",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "05196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland Heights, KY

Sources for this page

Verify at the official NPI Registry.