Individual provider Active NPI

Tracy McQueen, CRNA

  • Certified Registered Nurse Anesthetist
  • Winston Salem, NC
National Provider Identifier
1053830877
Registry record updated Sep 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
119052 Issued in NC
Practice address
1 Medical Center Blvd
Winston Salem, NC 27157-0001
Phone
(336) 409-7667
NPI assigned
Sep 13, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 119052 NC Primary

Addresses

Primary practice location

1 Medical Center Blvd
Winston Salem, NC 27157-0001

Mailing address

208 Vancouver CT
Kernersville, NC 27284-7238

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171209000014 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 5698033181 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Wake Forest University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
5723NCMDOral and Maxillofacial Surgery (Dentist)
119052NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Rowan Medical Center, LLC CurrentSince Dec 21, 2020 Accepting new patients
Rowan Regional Medical Center CurrentSince Dec 21, 2020 Accepting new patients
Novant Health Rowan Medical Center LLC Nurse Anesthetist, Certified Registered Current Accepting new patients
Wake Forest University Health Sciences CurrentSince Sep 19, 2017 Accepting new patients

Locations

612 Mocksville Ave
Salisbury, NC 28144
Phone (704) 210-5000

1950 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 718-0600

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

Organizations & group practices 4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1505260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505260800000",
    "number": "1053830877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 VANCOUVER CT",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272847238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-409-7667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCQUEEN",
        "first_name": "TRACY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-13",
        "last_updated": "2017-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "119052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2017; 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.