Individual provider Active NPI

Carine Aurora Tabak, MD

  • Internal Medicine Physician
  • Wichita, KS
National Provider Identifier
1962204180
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
3018913 Issued in MA
Practice address
1010 N Kansas St
Wichita, KS 67214-3124
Phone
(316) 293-2635
NPI assigned
Mar 26, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 3018913 MA Primary

Addresses

Primary practice location

1010 N Kansas St
Wichita, KS 67214-3124

Mailing address

800 Washington St
Boston, MA 02111-1552

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250708003185 MA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 2365956737

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
3018913MAMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1742947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1962204180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WASHINGTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021111552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 N KANSAS ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672143124",
            "telephone_number": "316-293-2635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABAK",
        "first_name": "CARINE",
        "middle_name": "AURORA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-03-26",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "3018913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

Verify at the official NPI Registry.