Individual provider Active NPI

Tracy McKelvey, RD

  • Registered Dietitian
  • Irvine, CA
National Provider Identifier
1053089946
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
819517 Issued in CA
Practice address
19722 Macarthur Blvd
Irvine, CA 92612-2404
Phone
(949) 824-8770
NPI assigned
Sep 3, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 819517 CA Primary

Addresses

Primary practice location

19722 Macarthur Blvd
Irvine, CA 92612-2404

Mailing address

18735 Fairfax LN
Huntington Beach, CA 92648-7018
Phone (714) 915-1539

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL Irvine
CONNECT URL Irvine

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211222001391 CA Practitioner - Registered Dietitian Or Nutrition Professional 5193116341 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorialcare Medical FoundationGroup PAC ID 8729277314, 555 clinicians

Practice addresses (Care Compare)

11420 Warner Ave
Fountain Valley, CA 92708-2529
Phone (714) 549-1300

Merit-based Incentive Payment System (MIPS)

Final score
87.17 of 100Reported as group
Quality
81.15
Promoting interoperability
100
Improvement activities
40
Cost
71.64

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation CurrentSince Dec 15, 2021 Accepting new patients
Bristol Park Medical Group, Inc Past Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

18785 Brookhurst St
Ste 200
Fountain Valley, CA 92708
Phone (714) 378-5330

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

11420 Warner Ave
Fountain Vly, CA 92708
Phone (714) 549-1300

4050 Barranca Pkwy
Ste 170
Irvine, CA 92604
Phone (949) 551-1090

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

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": "1630627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1053089946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18735 FAIRFAX LN",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926487018",
            "telephone_number": "714-915-1539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19722 MACARTHUR BLVD",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926122404",
            "telephone_number": "949-824-8770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKELVEY",
        "first_name": "TRACY",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-03",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "819517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Irvine",
            "affiliation": "N",
            "address_1": "19722 MacArthur Blvd",
            "city": "Irvine",
            "state": "CA",
            "country_code": "US",
            "postal_code": "926122404",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Irvine",
            "affiliation": "N",
            "address_1": "19722 MacArthur Blvd",
            "city": "Irvine",
            "state": "CA",
            "country_code": "US",
            "postal_code": "926122404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.