Individual provider Active NPI

Chris Ann Tallbacka, OT

  • Occupational Therapist
  • Port St Lucie, FL
National Provider Identifier
1891074050
Registry record updated Feb 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OT3086 Issued in FL
Practice address
9077 S Federal Hwy
Port St Lucie, FL 34952-3405
Phone
(772) 335-4770
Fax
(772) 335-4133
NPI assigned
Aug 5, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X OT3086 FL Primary

Addresses

Primary practice location

9077 S Federal Hwy
Port St Lucie, FL 34952-3405

Mailing address

9077 S Federal Hwy
Port St Lucie, FL 34952-3405
Phone (772) 335-4770

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111222000250 FL Practitioner - Occupational Therapist in Private Practice 3870769813 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mark J Powers MD PA Florida Orthopaedic SpecialistsGroup PAC ID 5496748782, 14 clinicians

Practice addresses (Care Compare)

9077 S Federal Hwy
Port St Lucie, FL 34952-3405
Phone (772) 398-7336

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mark J Powers MD PA Florida Orthopaedic Specialists CurrentSince Nov 30, 2011 Accepting new patients
Mark J Powers MD PA Florida Orthopaedic Specialists CurrentSince Nov 30, 2011 Accepting new patients

Locations

9077 S US Highway 1
Port St Lucie, FL 34952
Phone (407) 335-4770

1151 SE Indian St
Stuart, FL 34997
Phone (772) 335-4770

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581033600000",
    "number": "1891074050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9077 S FEDERAL HWY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349523405",
            "telephone_number": "772-335-4770",
            "fax_number": "772-335-4133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9077 S FEDERAL HWY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349523405",
            "telephone_number": "772-335-4770",
            "fax_number": "772-335-4133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALLBACKA",
        "first_name": "CHRIS",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-05",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT3086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.