Tracy Lynne Shaub, D.O.

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

34005750M Issued in OH

Practice address

2ND Floor Parks Hall
Athens, OH 45701

Phone

(740) 593-2516

Fax

(740) 593-2905

NPI assigned

Feb 7, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Cleveland Clinic Foundation

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1679525919
  Medicare reassignment NPD
• Athens Medical Associates, LLC

  • Family Medicine Physician
  • Athens, OH
  • NPI 1982714358
  NPD (past)

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507161600000",
    "number": "1043282684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "246 PARKS HALL",
            "city": "ATHENS",
            "state": "OH",
            "postal_code": "457011359",
            "telephone_number": "740-593-2672",
            "fax_number": "740-593-2905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2ND FLOOR PARKS HALL",
            "city": "ATHENS",
            "state": "OH",
            "postal_code": "45701",
            "telephone_number": "740-593-2516",
            "fax_number": "740-593-2905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAUB",
        "first_name": "TRACY",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-07",
        "last_updated": "2017-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "OH",
            "license": "34005750M",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0165922",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jena Sharb
• Jacelynn Renae Sharp, QMHS
• Jazmynn Sharp, QMHS
• Johari Sharp, LPC
• Mackenzie T Sharpshair, QMHS
• Regina Shavers
• Kerri A. Shaw, MSW, LISW
• Morgan Shaw
• Tierra Ashante Shaw
• Danielle Dawn Sheets

• Geriatric Medicine (Family Medicine) Physician in Athens, OH
• Providers in Athens, OH by specialty
• Geriatric Medicine (Family Medicine) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 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.