Individual provider Active NPI

Alexa Tkacik, FNP

  • Family Nurse Practitioner
  • Boardman, OH
National Provider Identifier
1912627647
Registry record updated Sep 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F05220178 Issued in OH
Practice address
250 Debartolo PL
Boardman, OH 44512-7004
Phone
(330) 314-9100
NPI assigned
Sep 1, 2022
Last updated
Sep 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F05220178 OH Primary

Addresses

Primary practice location

250 Debartolo PL
Boardman, OH 44512-7004

Mailing address

250 Debartolo PL
Boardman, OH 44512-7004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20221014002567 OH Practitioner - Nurse Practitioner 4183090244 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Triad Health Services LLCGroup PAC ID 9032367917, 252 clinicians

Practice addresses (Care Compare)

250 Debartolo PL
Suite 1000
Youngstown, OH 44512-6090
Phone (330) 729-8000

7629 Market St
Youngstown, OH 44512-6051

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
71.12
Promoting interoperability
100
Improvement activities
40
Cost
75.36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F05220178OHMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Triad Health Services, LLC Family CurrentSince Oct 1, 2022 Accepting new patients
The Surgery Center at Southwoods, LLC Past Accepting new patients

Locations

100 Debartolo Pl
Ste 200
Youngstown, OH 44512
Phone (330) 965-7828

250 Debartolo Pl
Youngstown, OH 44512
Phone (330) 314-9100

250 Debartolo Pl
Ste C
Youngstown, OH 44512

7629 Market St
Ste 250
Youngstown, OH 44512
Phone (330) 729-9480

7630 Southern Blvd
Youngstown, OH 44512
Phone (330) 729-8000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1661990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1912627647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 DEBARTOLO PL",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445127004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 DEBARTOLO PL",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445127004",
            "telephone_number": "330-314-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TKACIK",
        "first_name": "ALEXA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-01",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "F05220178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boardman, OH

Sources for this page

Verify at the official NPI Registry.