Tina Renae Porzukowiak, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

0973 Issued in NH

Practice address

6 Tsienneto Rd Ste 101
Derry, NH 03038-1584

Phone

(603) 434-4193

Fax

(603) 437-6804

NPI assigned

Jun 20, 2006

Last updated

Dec 17, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tina.porzukowiak.p3@direct.midwesternuniversity.nextgenshare.com

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.

• Cigna Health Care of Arizona Inc.

  dba EVERNORTH Care Group Paseo Multi-Specialty Center

  • Multi-Specialty Clinic/Center
  • Glendale, AZ
  • NPI 1689745333
  NPD
• Cigna Healthcare of Arizona, Inc.

  dba EVERNORTH Care Group

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1073626404
  NPD

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1952347080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 TSIENNETO RD",
            "address_2": "STE 101",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "030381584",
            "telephone_number": "603-434-4193",
            "fax_number": "603-437-6804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 TSIENNETO RD STE 101",
            "city": "DERRY",
            "state": "NH",
            "postal_code": "030381584",
            "telephone_number": "603-434-4193",
            "fax_number": "603-437-6804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORZUKOWIAK",
        "first_name": "TINA",
        "middle_name": "RENAE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-20",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NH",
            "license": "0973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3113899",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pleasant Valley Opco LLC (Pleasant Valley Nursing and Rehab Center)
• Pleasant Valley Operating Company LLC (Pleasant Valley Nuring Center)
• Pleasant Valley SNF LLC (Pleasant Valley Nursing and Rehab Center)
• Debra Poggi, RN, HEALTH EDUCATOR
• Sarah Pongratz
• Quarry State Inpatient Services, LLC
• Quest Diagnostics LLC
• Victor Joseph Quijano Jr., DPM, PHD
• Vipra Arun Rai, RD, LD, CDE
• Landrie Elizabeth Ramon

• Optometrist in Derry, NH
• Providers in Derry, NH by specialty
• Optometrist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.