Monica Tirtarahardja, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9112886 Issued in FL

Practice address

5503 S Congress Ave Ste 204
Lake Worth, FL 33462-6626

Phone

(561) 410-5110

NPI assigned

Feb 27, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

South Florida NeurosurgeryGroup PAC ID 9436389970, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellington Regional Medical Center Hospital, Wellington, FL, CCN 100275

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• South Florida Neurosurgery

  • Neurological Surgery Physician
  • Atlantis, FL
  • NPI 1336560853
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Wellington Regional Medical Center LLC

  • General Acute Care Hospital
  • Wellington, FL
  • NPI 1720078702
  Care Compare affiliation

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594512000000",
    "number": "1770117830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5503 S CONGRESS AVE STE 204",
            "city": "ATLANTIS",
            "state": "FL",
            "postal_code": "334626626",
            "telephone_number": "561-410-5110",
            "fax_number": "561-328-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5503 S CONGRESS AVE STE 204",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334626626",
            "telephone_number": "561-410-5110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIRTARAHARDJA",
        "first_name": "MONICA",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-27",
        "last_updated": "2020-07-12",
        "certification_date": "2020-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9112886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thoughts Feelings Behaviors Health Services LLC
• Brenton David Thrasher, M.D.
• Tier One Laboratories LLC
• Ryan Tinio
• Genee Tinsley
• TNR Staffing, LLC
• Quincy M Tobon
• Eija Toivonen Wood, NPRN
• Annia Toledano Guerra, APRN
• Bayardo Tom

• Surgical Physician Assistant in Lake Worth, FL
• Providers in Lake Worth, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.