Active NPI
Tatjana Mondom, MD
- Family Medicine Physician
- Utica, NY
National Provider Identifier
1851353148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 227664-1
- Practice address
- 1656 Champlin Ave
Utica, NY 13502-4830 - Phone
- (315) 624-6467
- Fax
- (315) 624-6469
- NPI assigned
- Apr 4, 2006
- Last updated
- Dec 7, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 227664-1 | NY | Primary |
Addresses
Primary practice location
1656 Champlin Ave
Utica, NY 13502-4830
Mailing address
1656 Champlin Ave
Utica, NY 13502-4830
Phone (315) 624-6467
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02370285 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
111 Hospital Dr
Utica, NY 13502-2517
Phone (315) 624-6000
1676 Sunset Ave
Utica, NY 13502-5416
Phone (315) 625-6000
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.28 of 100
- Quality
- 75.06
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 69.26
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 227664-1 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MVHS Inc | Past | Accepting new patients | |
| MVHS Inc | Past | Accepting new patients |
Interoperability endpoints
- tmondom9712@mvhealthsystem.direct-ci.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, 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": "1144108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449446400000",
"number": "1851353148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1656 CHAMPLIN AVE",
"city": "UTICA",
"state": "NY",
"postal_code": "135024830",
"telephone_number": "315-624-6467",
"fax_number": "315-624-6469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1656 CHAMPLIN AVE",
"city": "UTICA",
"state": "NY",
"postal_code": "135024830",
"telephone_number": "315-624-6467",
"fax_number": "315-624-6469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONDOM",
"first_name": "TATJANA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-04",
"last_updated": "2015-12-07",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "227664-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02370285",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Utica, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; 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.