Jeffrey Tanita, M.D.
Individual provider Active NPI Family Medicine Physician · Olla, LA
NPI 1922040443 · NPPES record last updated Sep 22, 2014
Key facts
- NPI
- 1922040443
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 200484 (LA)
- Practice address
- 1136A N Pine Rd
Olla, LA 71465-4804 - Phone
- (318) 495-3880
- Fax
- (318) 495-3882
- NPI assigned
- Jun 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 24
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mt Grant General Hospital
Klickitat County Public Hospital District No 1
Practice addresses (Care Compare)
200 S a St
Hawthorne, NV 89415-1510
Phone (775) 945-2461
310 S Roosevelt St
Goldendale, WA 98620-9201
Phone (509) 486-2151
Hospital & facility affiliations
- Mount Grant General Hospital
- Klickitat Valley Hospital
- Mount Grant General Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in LA, WA, NV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060110000638 | LA | Practitioner - Family Practice |
1850314469 | Reassigns benefits to 7 organizations |
| I20200406000356 | WA | Practitioner - Emergency Medicine | 1850314469 | Reassigns benefits to 2 organizations |
| I20230425003031 | NV | Practitioner - Emergency Medicine | 1850314469 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 200484 | LA | MD | Family Medicine Physician |
Practice roles
Locations
118 N Hospital Dr
Abbeville, LA 70510
Phone (337) 893-5466
229 Saint John Ln
Covington, LA 70433
Phone (866) 875-9225
301 Memorial Dr
Donaldsonvlle, LA 70346
Phone (225) 473-7931
1310 W 7th St
Kaplan, LA 70548
Phone (318) 643-8300
336 N Hood St
Lk Providence, LA 71254
Phone (318) 559-4023
801 Poinciana Ave
Mamou, LA 70554
Phone (337) 457-5740
207 Jefferson St
Mansfield, LA 71052
Phone (318) 871-3109
254 Highway 3048
Rayville, LA 71269
Phone (318) 728-4181
401 E Vaughn Ave
Ruston, LA 71270
Phone (318) 254-2100
2106 Loop Rd
Winnsboro, LA 71295
Phone (318) 282-8482
310 S Roosevelt St
Goldendale, WA 98620
Phone (509) 486-2151
Interoperability endpoints
- jeffery.tanita.1@11938.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 200484 | LA | Yes |
Addresses
Primary practice location
1136A N Pine Rd
Olla, LA 71465-4804
Mailing address
1136A N Pine Rd
Olla, LA 71465-4804
Phone (318) 495-3880
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1449342 | Medicaid | LA | |
| 1054356 | Medicaid | LA |
Other providers in Olla, LA
- Breanne Smith
- Smotherman Inc
- Rickey Smotherman
- Allison Kendrick Stelly
- Surgeoncare Physicians of Louisiana, LLC
- Nuzhath Tasneem
All providers in Olla, LA · Family Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.