Individual provider Active NPI

Tara Difabio, CRNP

  • Nurse Practitioner
  • Flemington, NJ
National Provider Identifier
1730320417
Registry record updated May 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
SP009696 Issued in PA
Practice address
2100 Wescott Dr
Flemington, NJ 08822-4603
Phone
(908) 788-6461
Fax
(908) 788-6412
NPI assigned
Mar 10, 2009
Last updated
May 17, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X SP009696 PA
Nurse Practitioner 363L00000X SP009696 PA Primary

Addresses

Primary practice location

2100 Wescott Dr
Flemington, NJ 08822-4603

Mailing address

2100 Wescott Dr
Flemington, NJ 08822-4603
Phone (908) 788-6461

Other identifiers 1

IdentifierTypeStateIssuer
102878448MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090723000448 PA Practitioner - Nurse Practitioner 8123170073 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

925 Chestnut St
Suite 6
Philadelphia, PA 19107-4204

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP009696PAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson University Physicians Past Accepting new patients

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": "1236643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558051200000",
    "number": "1730320417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 WESCOTT DR",
            "city": "FLEMINGTON",
            "state": "NJ",
            "postal_code": "088224603",
            "telephone_number": "908-788-6461",
            "fax_number": "908-788-6412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 WESCOTT DR",
            "city": "FLEMINGTON",
            "state": "NJ",
            "postal_code": "088224603",
            "telephone_number": "908-788-6461",
            "fax_number": "908-788-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIFABIO",
        "first_name": "TARA",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-10",
        "last_updated": "2019-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP009696",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP009696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102878448",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flemington, NJ

Sources for this page

Verify at the official NPI Registry.