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TABETHA STATEN NP
NPI 1104342138
Nurse Practitioner - Gerontology in Green, OH

Active since August 22, 2017PECOS EnrolledAccepts Medicare Assignment
1700 BOETTLER RD STE 100, GREEN, OH 44685(330) 896-0009(330) 896-0032 Get Directions Write a Review

NPPES record last updated: July 2, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Tabetha Staten Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TABETHA STATEN NP (NPI 1104342138) is an individual gerontology provider in Green, Ohio, licensed in Ohio (APRN.CNP.021511) and active in the NPI registry since August 2017. She is enrolled in Medicare PECOS and is a graduate of Other (2017).

NPPES Registry Identity

NPI1104342138
Entity TypeIndividualFemale
Primary Taxonomy363LG0600X
Provider Legal NameTABETHA STATENCredential: NP
Location Address1700 BOETTLER RD STE 100Green, OH 44685-7793
Mailing Address944 Cherry St ECanal Fulton, OH 44614-8669 · (330) 896-0009 · Fax (330) 896-0032
Phone(330) 896-0009
Fax(330) 896-0032
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateAugust 22, 2017
Last NPPES UpdateJuly 2, 2026
NPPES CertifiedJuly 2, 2026
✔ NPI 1104342138 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · GerontologyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LG0600X
License✔ Licensed in OH · APRN.CNP.021511
1700 BOETTLER RD STE 100, Green, OH 44685
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, MedMutual, Oscar Insurance Corporation of Ohio and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tabetha Staten Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4486912706
PECOS Enrollment IDI20250807000856
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Tabetha Staten reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Community Health Care Inc.
7.7 mi
Family Medicine
944 CHERRY ST E
Canal Fulton, OH 44614
  • Reassigned Medicare billing, Ohio enrollment
  • 68 clinicians in this Medicare group
NPI 1114902137 (330) 854-4574
Illumia Health LLC
16 mi
Hospice and Palliative Medicine
4040 EMBASSY PKWY STE 410
Akron, OH 44333
  • Reassigned Medicare billing, Ohio enrollment
  • 44 clinicians in this Medicare group
NPI 1740024397 (330) 576-5405

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 44685 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.72 typical visit price
range $54.34 – $166.65
Typical copayment $21.18 (range $13.58 – $41.66)
Most-billed visit code 99203
Established Patient
$96.44 typical visit price
range $17.10 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PAULO BORGES M.D.
Family Medicine
1700 BOETTLER RD STE 100
UNIONTOWN, OH 44685
Stark County (330) 896-0009
MRS. ELISABETH J. GRUBER DILLARD LISW
Social Worker (Clinical)
1700 BOETTLER RD STE 100
UNIONTOWN, OH 44685
Stark County (330) 896-0009
KELSEY CASANO NP
Nurse Practitioner (Primary Care)
1700 BOETTLER RD STE 100
UNIONTOWN, OH 44685
Stark County (330) 896-0009

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tabetha Staten's NPI number?

The NPI number for Tabetha Staten is 1104342138. It was assigned to this individual provider in the NPPES registry on August 22, 2017.

Where is Tabetha Staten located?

Tabetha Staten practices at 1700 Boettler Rd Ste 100, Green, OH 44685. The listed phone number is (330) 896-0009.

What is Tabetha Staten's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.

Is Tabetha Staten enrolled in Medicare?

Yes. Tabetha Staten is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Tabetha Staten's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tabetha Staten reassigns Medicare benefits to 2 organizations: Community Health Care Inc. (Canal Fulton, OH) and Illumia Health LLC (Akron, OH). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tabetha Staten's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Tabetha Staten accept?

Health plans from Anthem Blue Cross and Blue Shield, MedMutual, Oscar Insurance Corporation of Ohio and UnitedHealthcare list Tabetha Staten as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Tabetha Staten was last updated on July 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.