Individual provider Active NPI

Tara Thompson, PA-C

  • Physician Assistant
  • Mesa, AZ
National Provider Identifier
1942726047
Registry record updated Apr 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6897 Issued in AZ
Practice address
4320 E. Presidio Street
#101
Mesa, AZ 85215-1165
Phone
(480) 706-9430
Fax
(480) 378-2273
NPI assigned
Aug 21, 2017
Last updated
Apr 19, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 6897 AZ Primary

Addresses

Primary practice location

4320 E. Presidio Street
#101
Mesa, AZ 85215-1165

Mailing address

5155 E. Eagle Drive
#20730
Mesa, AZ 85277-3031
Phone (520) 407-6750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20180102002310 AZ Practitioner - Physician Assistant 1052679669 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
360Care Current Accepting new patients
Honorhealth-Fastmed Ambulatory Holdings LLC CurrentSince Dec 1, 2020 Accepting new patients
Honorhealth-Fastmed Ambulatory Holdings LLC CurrentSince Dec 1, 2020 Accepting new patients
Honorhealth-Fastmed Ambulatory Holdings LLC Current Accepting new patients
Tri-City Express Care, PLLC CurrentSince Nov 16, 2020 Accepting new patients
Honorhealth-Fastmed Ambulatory Holdings LLC CurrentSince Dec 1, 2020 Accepting new patients
DM&a Holdings LLC PastSince May 12, 2024 Accepting new patients

Locations

415 N Val Vista Dr
Ste 101
Mesa, AZ 85213
Phone (480) 654-5661

3244 S Mill Ave
Ste 101
Tempe, AZ 85282
Phone (480) 214-0621

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524096000000",
    "number": "1942726047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5155 E. EAGLE DRIVE",
            "address_2": "#20730",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852773031",
            "telephone_number": "520-407-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 E. PRESIDIO STREET",
            "address_2": "#101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852151165",
            "telephone_number": "480-706-9430",
            "fax_number": "480-378-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "TARA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-21",
        "last_updated": "2018-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.