MRS. TARA ROBERTSON (FNP-C) – Family Nurse Practitioner, NPI 1104204122

MRS. TARA ROBERTSON (FNP-C) is a healthcare provider. based in Quincy, Illinois. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP-C. They hold a License No. 209012568 (IL). The NPI Number for MRS. TARA ROBERTSON (FNP-C) is 1104204122

Main info

Female
12 Years Of Experience
Accepts Medicare Assignment
Name
MRS. TARA ROBERTSON (FNP-C)
NPI
1104204122
Phone
(217) 440-5089
Address
1531 WINSOR DR
Enumeration Date
11 May 2015
Last Update Date
26 March 2019

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2179197217
Graduation Year
2014 (12 years ago)
PAC ID
2062707961
Group Practice PAC ID
7214282227
Professional Enrollment ID
I20200513002515
Address ID
MO634016884HA163XXDRXX301
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience36
Completeness75
Years active:11State licenses:1Digital endpointsOther names

11,632 NURSE PRACTITIONER in IL

Provider Addresses for MRS. TARA ROBERTSON (FNP-C)

  • 1531 WINSOR DR

    QUINCY, IL 623051471

    Phone: (217) 440-5089

    Type: Mailing

  • 1 DOT WAY

    MOUNT STERLING, IL 623531664

    Phone: (217) 773-6060

    Fax: (217) 436-6762

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 117 Open Payments records for all available years, with a total value of $2,452.

Total Amount is formed as General ($2,452) + Research ($0) + Ownership ($0) = $2,452.

Last reported payment date: 2024-12-11 • Largest payer in this snapshot: Janssen Biotech, Inc. ($697).

Total Amount

$2,452

General + Research + Ownership

Payments

117

Total payment records

General Amount

$2,452

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-11

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2020-05-13

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20160816002773INurse PractitionerILTBD
I20200513002515INurse PractitionerMOTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
17003Destruction of precancer skin growth, 2-14 growths10625$0
99213Established patient office or other outpatient visit, 20-29 minutes5445$0
17000Destruction of precancer skin growth, 1 growth3629$0
17110Destruction of skin growth, 1-14 growths2417$0
11301Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm1312$0
View full utilization report →

Insurance plans in this area (ZIP 62305)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7214282227View full group profile
NameSpecialtyState
Nurse PractitionerMO
Nurse PractitionerMO
-MO
Nurse PractitionerMO
D E R M A T O L O G YMO

Reviews

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Frequently asked questions

What is MRS. TARA ROBERTSON (FNP-C)'s NPI number?
MRS. TARA ROBERTSON (FNP-C)'s NPI is 1104204122 — the number used across U.S. healthcare to identify this provider.
Active or inactive — what applies to MRS. TARA ROBERTSON (FNP-C)?
You should see MRS. TARA ROBERTSON (FNP-C) as active in CMS-hosted NPPES data.
How would a patient describe MRS. TARA ROBERTSON (FNP-C)'s focus?
For MRS. TARA ROBERTSON (FNP-C), the primary taxonomy reads as Family Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Is MRS. TARA ROBERTSON (FNP-C) associated with Quincy?
Public fields place MRS. TARA ROBERTSON (FNP-C) around Quincy, Illinois. Always confirm the exact site before visiting.
When was this NPI issued?
Enumeration for MRS. TARA ROBERTSON (FNP-C) is noted as May 11, 2015 where the registry provides it.

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