Tara Shanti Kane, PNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95015265 Issued in CA

Practice address

1260 Morena Blvd Ste 100
San Diego, CA 92110-3850

Phone

(619) 398-0355

Fax

(619) 398-0350

NPI assigned

Nov 27, 2007

Last updated

Feb 23, 2022By 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 5

Addresses

Other identifiers 3

Other names 1

• Tara S Wunderlich Former name

Medicare fee-for-service enrollment

Enrolled in NY, IA, WI, ND, AR, WA, MA, MO8 enrollments

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 8

Specialty

Nurse Practitioner

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Evizzit of Iowa Psychiatry PCGroup PAC ID 2860825924, 52 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Evizzit of Iowa Psychiatry PC

  dba Integrated Telehealth Partners

  • Psychiatry Physician
  • West Des Moines, IA
  • NPI 1740841188

  AR, MA, MO, ND, Psychiatric/Mental Health, WA, WI

  Medicare reassignment Care Compare group NPD
• Broadlawns Medical Center

  • General Acute Care Hospital
  • Des Moines, IA
  • NPI 1467447508
  Medicare reassignment NPD
• Community Medical Associates, Inc.

  • Family Medicine Physician
  • Lawrence, MA
  • NPI 1144544040
  Medicare reassignment NPD
• Family Services of Chemung County, Inc.

  • Counselor
  • Elmira, NY
  • NPI 1619922432

  Nurse Practitioner

  Medicare reassignment NPD
• Family Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Poughkeepsie, NY
  • NPI 1316939457
  Medicare reassignment NPD
• Integrated Telehealth Medicine PC

  • Psychiatry Physician
  • Oceanside, NY
  • NPI 1124870233

  Psychiatric/Mental Health

  Medicare reassignment NPD
• Watertown Physician Practices LLC

  • Family Medicine Physician
  • Watertown, WI
  • NPI 1770964363
  Medicare reassignment NPD
• Black River Health Inc

  • Critical Access Hospital
  • Black River Falls, WI
  • NPI 1811940331
  Medicare reassignment
• Broadlawns Medical Center

  • Pharmacy
  • Des Moines, IA
  • NPI 1013197060
  NPD
• Watertown Physician Practices LLC

  • Obstetrics & Gynecology Physician
  • Watertown, WI
  • NPI 1225412265

  Nurse Practitioner

  NPD
• Watertown Physician Practices LLC

  dba WRMC Directions Counseling Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Watertown, WI
  • NPI 1760866891

  Psychiatric/Mental Health

  NPD
• Evizzit of Iowa Psychiatry PC

  • Adult Mental Health Clinic/Center
  • West Des Moines, IA
  • NPI 1679233183
  NPD (past)

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1982885414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 MORENA BLVD STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103850",
            "telephone_number": "619-398-0355",
            "fax_number": "619-398-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 MORENA BLVD STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921103850",
            "telephone_number": "619-398-0355",
            "fax_number": "619-398-0350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 N 3rd St",
            "address_purpose": "LOCATION",
            "city": "Harrisburg",
            "state": "PA",
            "postal_code": "171101904",
            "country_code": "US",
            "telephone_number": "717-782-4734",
            "fax_number": "717-782-4727",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5455 Almira Dr NE",
            "address_purpose": "LOCATION",
            "city": "Bremerton",
            "state": "WA",
            "postal_code": "983118331",
            "country_code": "US",
            "telephone_number": "360-415-5870",
            "fax_number": "360-478-0951",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "899 Hwy 287 Ste 300",
            "address_purpose": "LOCATION",
            "city": "Broomfield",
            "state": "CO",
            "postal_code": "800207319",
            "country_code": "US",
            "telephone_number": "303-443-8500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7440 W Marginal Way S",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981084141",
            "country_code": "US",
            "telephone_number": "206-768-1990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANE",
        "first_name": "TARA",
        "middle_name": "SHANTI",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-27",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP017314",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "APN.0995403-NP",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60794626",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "400990",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95015265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "911020106",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPLOYER MEDICARE NUMBER",
            "identifier": "39062A",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPLOYER MEDICAID NUMBER",
            "identifier": "00618162",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "WUNDERLICH",
            "middle_name": "S",
            "credential": "PMHNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kara Elizabeth Kane, PA-C
• Kerry Kane, MFT
• Patricia Lea Kane
• Sadie Patricia Kane, PMHNP-BC
• Stacey Marie Kane
• John Terry Kanegaye, M.D.
• Manabu Kaneko
• Jason Alan Kanel, M.D.
• Ryan J Kaner, PSY.D.
• Christy Kaneshige

• Psychiatric/Mental Health Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.