TARA ANTONUCCI AGACNP-BC
NPI 1598476038
Nurse Practitioner in San Diego, CA

Q: What is Tara Antonucci's NPI number?

The NPI number for Tara Antonucci is 1598476038. It was assigned to this individual provider in the NPPES registry on December 6, 2022.

Q: What is Tara Antonucci's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Tara Antonucci was last updated on April 5, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.

Active since December 06, 2022PECOS EnrolledAccepts Medicare Assignment

200 W ARBOR DR, SAN DIEGO, CA 92103(800) 926-8273 Get Directions Write a Review

NPPES record last updated: April 5, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 5, 2023, Dec 6, 2022 (2 updates tracked since 2022).

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About Tara Antonucci Agacnp-bc NPPES

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

TARA ANTONUCCI AGACNP-BC (NPI 1598476038) is an individual nurse practitioner in San Diego, California, licensed in California (95021759) and active in the NPI registry since December 2022. She is enrolled in Medicare PECOS, maintains a secondary practice location in La Jolla, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1598476038

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameTARA ANTONUCCICredential: AGACNP-BC

Location Address200 W ARBOR DRSan Diego, CA 92103-9000

Mailing AddressPo Box 232410San Diego, CA 92193-2410 · (800) 926-8273

Phone(800) 926-8273

Sole ProprietorNo

Medical School CMSOtherGraduated 2022

Enumeration DateDecember 6, 2022

Last NPPES UpdateApril 5, 20232 updates tracked since enumeration

NPPES CertifiedApril 5, 2023

✔ NPI 1598476038 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in CA · 95021759

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedNurse Practitioner · Acute CareTaxonomy 363LA2100X · License 95021759 (CA)

200 W ARBOR DR, San Diego, CA 92103

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Secondary Practice Location 1

Location 19434 Medical Center DrLA Jolla, CA 92037-1337 · Phone (858) 657-8330

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 Antonucci Agacnp-bc 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 ID5799150512

PECOS Enrollment IDI20230410001960

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92103 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

$94.87 typical visit price

range $62.10 – $184.71

Typical copayment $23.71 (range $15.52 – $46.17)

Most-billed visit code 99203

Established Patient

$108.42 typical visit price

range $20.62 – $151.42

Typical copayment $27.10 (range $5.15 – $37.85)

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 20

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

DR. RAMIN MOTARJEMI M.D.

Internal Medicine (Geriatric Medicine)