NPIMap

Individual provider Active NPI

Tara T Walker, PA

  • Medical Physician Assistant
  • Madison, MS
National Provider Identifier
1730798950
Registry record updated Jul 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA00514 Issued in MS
Practice address
106 Highland Way Ste 200
Madison, MS 39110-6933
Phone
(601) 200-4141
Fax
(601) 200-4150
NPI assigned
Jul 23, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA00514 MS Primary

Addresses

Primary practice location

106 Highland Way Ste 200
Madison, MS 39110-6933

Mailing address

PO Box 23666
Jackson, MS 39225-3666
Phone (601) 200-4141

Other practice location 1

106 Highland Way Ste 103
Madison, MS 39110-6930
Phone (601) 200-4750

Other identifiers 3

IdentifierTypeStateIssuer
06934765MedicaidMS
PA00514OtherMSMS LICENSE
1K0604OtherMSMEDICARE ST DOM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201210001965 MS Practitioner - Physician Assistant 9638581978 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

106 Highland Way
Madison, MS 39110-6933

106 Highland Way
Suite 103 St Dominic Family Practice Madis
Madison, MS 39110-6930
Phone (601) 200-4750

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.09 of 100Reported as apm
Quality
73.43
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA00514MSMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St Dominic Medical Associates LLC CurrentSince Jan 1, 2021 Accepting new patients
St Dominic Medical Associates LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: twalker2546064@direct.casso.us.com

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1730798950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-200-4141",
            "fax_number": "601-200-4150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 HIGHLAND WAY STE 200",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106933",
            "telephone_number": "601-200-4141",
            "fax_number": "601-200-4150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "106 Highland Way Ste 103",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "MS",
            "postal_code": "391106930",
            "country_code": "US",
            "telephone_number": "601-200-4750",
            "fax_number": "601-200-4740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALKER",
        "first_name": "TARA",
        "middle_name": "T",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-23",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MS",
            "license": "PA00514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06934765",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MS LICENSE",
            "identifier": "PA00514",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ST DOM",
            "identifier": "1K0604",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

Verify at the official NPI Registry.