Individual provider Active NPI

Rebecca Tannis, PA-C

  • Medical Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1922488303
Registry record updated Sep 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
018619 Issued in NY
Practice address
374 Stockholm St
Brooklyn, NY 11237-4006
Phone
(718) 963-7272
NPI assigned
Jun 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 018619 NY Primary

Addresses

Primary practice location

374 Stockholm St
Brooklyn, NY 11237-4006

Mailing address

374 Stockholm St
Brooklyn, NY 11237-4006

Other practice location 1

150 55th St
Brooklyn, NY 11220-2508
Phone (718) 630-4697

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rtannis288480@nyumc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20150727001608 NY Practitioner - Physician Assistant 0345554952 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
018619NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Nov 9, 2019 Accepting new patients
New York University CurrentSince Nov 9, 2019 Accepting new patients

Locations

150 55th St
Brooklyn, NY 11220
Phone (718) 630-7185

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Organizations & group practices 4

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": "1433116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1922488303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 STOCKHOLM ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 STOCKHOLM ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112374006",
            "telephone_number": "718-963-7272"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 55th St",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112202508",
            "country_code": "US",
            "telephone_number": "718-630-4697",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANNIS",
        "first_name": "REBECCA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-01",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "018619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rtannis288480@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "150 55th St",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112202508",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.