Active NPI
Tara Ann Hodge, MED, ATC
- Specialist
- San Rafael, CA
National Provider Identifier
1881006179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 1475 Grand Ave.
San Rafael, CA 94901 - Phone
- (415) 482-1807
- Fax
- (415) 482-1852
- NPI assigned
- May 21, 2014
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
1475 Grand Ave.
San Rafael, CA 94901
Mailing address
50 Acacia Ave
San Rafael, CA 94901-2230
Phone (415) 482-1807
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1400630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400630400000",
"number": "1881006179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 ACACIA AVE",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949012230",
"telephone_number": "415-482-1807",
"fax_number": "415-482-1852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1475 GRAND AVE.",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "94901",
"telephone_number": "415-482-1807",
"fax_number": "415-482-1852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HODGE",
"first_name": "TARA",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "MED, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-21",
"last_updated": "2014-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.