Individual provider Active NPI

Emma Tracy McMahon

  • Pediatric Nurse Practitioner
  • Tucson, AZ
National Provider Identifier
1043822299
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
298080 Issued in AZ
Practice address
535 N Wilmot Rd Ste 101
Tucson, AZ 85711-2683
Phone
(520) 694-5437
NPI assigned
Aug 19, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 298080 AZ Primary

Addresses

Primary practice location

535 N Wilmot Rd Ste 101
Tucson, AZ 85711-2683

Mailing address

535 N Wilmot Rd Ste 101
Tucson, AZ 85711-2683

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240321000651 AZ Practitioner - Nurse Practitioner 8325485733 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
298080AZMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Banner-University Medical Group Current Accepting new patients
Banner-University Medical Group CurrentSince Mar 1, 2024 Accepting new patients
Banner-University Medical Group CurrentSince Mar 1, 2024 Accepting new patients

Locations

2800 E Ajo Way
Tucson, AZ 85713
Phone (520) 294-4471

6261 N La Cholla Blvd
Tucson, AZ 85741
Phone (520) 297-1490

535 N Wilmot Rd
Ste 101
Tucson, AZ 85711
Phone (520) 694-9988

6261 N La Cholla Blvd
Ste 131
Tucson, AZ 85741
Phone (301) 984-1979

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711324800000",
    "number": "1043822299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 N WILMOT RD STE 101",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857112683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 N WILMOT RD STE 101",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857112683",
            "telephone_number": "520-694-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMAHON",
        "first_name": "EMMA",
        "middle_name": "TRACY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-19",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "298080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.