Tabetha Staten, NP - Medicare Nurse Practitioner in Green, OH

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Tabetha Staten, NP is a medicare enrolled "Nurse Practitioner - Gerontology" in Green, Ohio. She graduated from nursing school in 2017 and has 9 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Illumia Health Llc and her current practice location is 1700 Boettler Rd Ste 100, Green, Ohio. You can reach out to her office (for appointments etc.) via phone at (330) 896-0009.

Tabetha Staten is licensed to practice in Ohio (license number APRN.CNP.021511) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1104342138.

Contact Information

Tabetha Staten, NP
1700 Boettler Rd Ste 100,
Green, OH 44685-7793
(330) 896-0009
(330) 896-0032

Map and Direction




Provider's Profile

Full NameTabetha Staten
GenderFemale
SpecialityNurse Practitioner
Experience9 Years
Location1700 Boettler Rd Ste 100, Green, Ohio
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Tabetha Staten graduated from nursing school in 2017
  NPI Data:
  • NPI Number: 1104342138
  • Provider Enumeration Date: 08/22/2017
  • Last Update Date: 07/02/2026
  Medicare PECOS Information:
  • PECOS PAC ID: 4486912706
  • Enrollment ID: I20250807000856

Medical Identifiers

Medical identifiers for Tabetha Staten such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1104342138NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LG0600XNurse Practitioner - Gerontology APRN.CNP.021511 (Ohio)Primary

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Illumia Health Llc781042430633

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Tabetha Staten allows following entities to bill medicare on her behalf.
Entity NameIllumia Health LLC
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1740024397
PECOS PAC ID: 7810424306
Enrollment ID: O20241223000539

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Tabetha Staten is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Tabetha Staten, NP
944 Cherry St E,
Canal Fulton, OH 44614-8669

Ph: (330) 896-0009		Tabetha Staten, NP
1700 Boettler Rd Ste 100,
Green, OH 44685-7793

Ph: (330) 896-0009

Reviews and Comments


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Natalie Bilinovich, CNP
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Practice Location: 1587 Boettler Rd Ste 140, Green, OH 44685
Phone: 330-665-0555    Fax: 330-665-0556

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.