Tracy Jacinda Branch, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

007573 Issued in NY

Practice address

8501 Plum Creek Dr
Gaithersburg, MD 20882-4438

Phone

(240) 246-7510

NPI assigned

May 19, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1495152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495152000000",
    "number": "1003343138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5600 FISHERS LN # 16N164C",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208521750",
            "telephone_number": "301-443-0494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8501 PLUM CREEK DR",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208824438",
            "telephone_number": "240-246-7510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANCH",
        "first_name": "TRACY",
        "middle_name": "JACINDA",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-19",
        "last_updated": "2017-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "007573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana Bozzay, OTD
• Autumn S Bozzo, MSN, PMHNP-BC, RN
• BPG Premiercare LLC
• Oliver Brady
• Simone Bramble, LCSW-C
• Pernell J Brantley
• M. Miles Braun, M.D.
• Bravo Psychological Group LLC.
• Bravo Psychological Group, LLC
• Eric Ward Bravo, PSY.D.

• Medical Physician Assistant in Gaithersburg, MD
• Providers in Gaithersburg, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.