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TARA ROSE NIZAMOV PHYSICIAN ASSISTANT
NPI 1558179093
Physician Assistant in Mount Vernon, NY

Active since December 30, 2024PECOS EnrolledAccepts Medicare Assignment
12 N 7TH AVE, MOUNT VERNON, NY 10550(917) 557-9895 Get Directions Write a Review

NPPES record last updated: June 8, 2025. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Jun 8, 2025, Dec 31, 2024 (2 updates tracked since 2024).

About Tara Rose Nizamov Physician Assistant NPPES

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

TARA ROSE NIZAMOV PHYSICIAN ASSISTANT (NPI 1558179093) is an individual physician assistant in Mount Vernon, New York, licensed in New York (032848) and active in the NPI registry since December 2024. She is enrolled in Medicare PECOS, is affiliated with Montefiore Medical Center, and is a graduate of Mercy College (2024).

NPPES Registry Identity

NPI1558179093
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameTARA ROSE NIZAMOVCredential: PHYSICIAN ASSISTANT
Location Address12 N 7TH AVEMount Vernon, NY 10550-2026
Mailing Address12 N 7th AveMount Vernon, NY 10550-2026 · (914) 261-7448
Phone(917) 557-9895
Sole ProprietorNo
Medical School CMSMercy CollegeGraduated 2024
Enumeration DateDecember 30, 2024
Last NPPES UpdateJune 8, 20252 updates tracked since enumeration
NPPES CertifiedJune 8, 2025
✔ NPI 1558179093 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in NY · 032848
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
12 N 7TH AVE, Mount Vernon, NY 10550
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tara Rose Nizamov Physician Assistant 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 ID9032620091
PECOS Enrollment IDI20250617000611
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.

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Montefiore Medical Center

Acute Care Hospitals · Bronx, NY
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330059
Location111 East 210th StreetBronx, NY 10467 · Bronx County
Emergency services Birthing friendly

Montefiore Mount Vernon Hospital

Acute Care Hospitals · Mount Vernon, NY
OwnershipVoluntary non-profit - Private
CMS Certification Number330086
Location12 North 7th AvenueMount Vernon, NY 10550 · Westchester County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10550 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
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$83.44 typical visit price
range $21.66 – $164.45
Typical copayment $20.86 (range $5.41 – $41.11)
Most-billed visit code 99213
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 20

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

DR. CHIH-TANG CHANG
Specialist
12 N 7TH AVE
MOUNT VERNON, NY 10550
Westchester County (914) 660-8000
ARTHUR H. ELKIND,M.D.,P.C.
Clinic/Center
12 N 7TH AVE
MOUNT VERNON, NY 10550
Westchester County (914) 667-2230
MONTEFIORE MOUNT VERNON HOSPITAL
General Acute Care Hospital
12 N 7TH AVE
MOUNT VERNON, NY 10550
Westchester County (914) 664-8000
KENNETH R DEE MD
Radiology (Diagnostic Radiology)
12 N 7TH AVE
MOUNT VERNON, NY 10550
Westchester County (952) 595-1100
MR. ALAN PESCHIERA RPH
Pharmacist
12 N 7TH AVE
MOUNT VERNON, NY 10550
Westchester County (914) 361-6087
SUZANA PATEL PHARM D
Pharmacist
12 N 7TH AVE
MOUNT VERNON, NY 10550
Westchester County (914) 361-6087
DR. BALASA L PRASAD MD
Anesthesiology
12 N 7TH AVE, ANESTHESIA DEPT - 4TH FLOOR
MOUNT VERNON, NY 10550
Westchester County (914) 667-8136
SHARON DEGANI
Registered Nurse (Psychiatric/Mental Health)
12 N 7TH AVE
MOUNT VERNON, NY 10550
Westchester County (914) 361-7232

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 Tara Nizamov's NPI number?

The NPI number for Tara Nizamov is 1558179093. It was assigned to this individual provider in the NPPES registry on December 30, 2024.

Where is Tara Nizamov located?

Tara Nizamov practices at 12 N 7th Ave, Mount Vernon, NY 10550. The listed phone number is (917) 557-9895.

What is Tara Nizamov's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Tara Nizamov enrolled in Medicare?

Yes. Tara Nizamov 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.

Is Tara Nizamov affiliated with any hospitals?

According to CMS data, Tara Nizamov is affiliated with Montefiore Medical Center and Montefiore Mount Vernon Hospital.

When was this NPI record last updated?

The NPPES record for Tara Nizamov was last updated on June 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.