Individual provider Active NPI

Tara Marie Piccolo, NURSE PRACITIONER

  • Nurse Practitioner
  • Anglewood, NJ
National Provider Identifier
1861104515
Registry record updated Dec 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
26NJ01402700 Issued in NJ
Practice address
350 Angle Street
Anglewood, NJ 07631
Phone
(201) 894-3000
NPI assigned
Dec 14, 2022
Last updated
Dec 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 26NJ01402700 NJ Primary

Addresses

Primary practice location

350 Angle Street
Anglewood, NJ 07631

Mailing address

478 Abbott Avenue
Ridgefield, NJ 07657
Phone (201) 334-6634

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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

Enrollment IDStateProvider typePAC IDDetails
I20230602002036 NJ Practitioner - Nurse Practitioner 5698132801 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medical Associates of Englewood PCGroup PAC ID 1355512252, 538 clinicians

Practice addresses (Care Compare)

350 Engle St
6TH Floor Berrie
Englewood, NJ 07631-1808
Phone (201) 608-2800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.09 of 100Reported as apm
Quality
86.89
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Associates of Englewood, PC CurrentSince Feb 9, 2023 Accepting new patients

Locations

350 Engle St
Fl 6
Englewood, NJ 07631
Phone (201) 568-5250

24 Elm St
Ste 203
Harrington Pk, NJ 07640
Phone (201) 784-0123

30 Montgomery St
Ste 720
Jersey City, NJ 07302
Phone (212) 524-7766

Organizations & group practices 1

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": "1670976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1861104515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "478 ABBOTT AVENUE",
            "city": "RIDGEFIELD",
            "state": "NJ",
            "postal_code": "07657",
            "telephone_number": "201-334-6634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 ANGLE STREET",
            "city": "ANGLEWOOD",
            "state": "NJ",
            "postal_code": "07631",
            "telephone_number": "201-894-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICCOLO",
        "first_name": "TARA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-14",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ01402700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.