Individual provider Active NPI

Tracey Lynn Zollar, APNP

  • Family Nurse Practitioner
  • Green Bay, WI
National Provider Identifier
1063677557
Registry record updated Mar 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3443-33 Issued in WI
Practice address
1630 Commanche Ave
Green Bay, WI 54313-6089
Phone
(920) 430-4700
NPI assigned
Jul 23, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3443-33 WI Primary

Addresses

Primary practice location

1630 Commanche Ave
Green Bay, WI 54313-6089

Mailing address

1630 Commanche Ave
Green Bay, WI 54313-6089
Phone (920) 430-4700

Other identifiers 1

IdentifierTypeStateIssuer
36084800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20080827000495 WI Practitioner - Nurse Practitioner 1658447685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

1630 Commanche Ave
Green Bay, WI 54313-5753
Phone (920) 430-4700

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Current Accepting new patients
Bellin Memorial Hospital Inc CurrentSince Aug 18, 2008 Accepting new patients
Bellin Memorial Hospital CurrentSince Aug 18, 2008 Accepting new patients
Bellin Memorial Hospital Inc Past Accepting new patients

Locations

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

124 Siegler St
Green Bay, WI 54303
Phone (920) 494-9661

1630 Commanche Ave
Green Bay, WI 54313
Phone (920) 430-4700

2305 San Luis Pl
Green Bay, WI 54304
Phone (920) 494-2817

607 E Bronson Rd
Seymour, WI 54165
Phone (920) 833-6856

Interoperability endpoints

  • Direct secure messaging: tzollar917165@direct.emplifyhealth.org
  • Direct secure messaging: tzollar30741@direct.thedacare.org

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 2

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": "1216771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395187200000",
    "number": "1063677557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 COMMANCHE AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543136089",
            "telephone_number": "920-430-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 COMMANCHE AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543136089",
            "telephone_number": "920-430-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZOLLAR",
        "first_name": "TRACEY",
        "middle_name": "LYNN",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-23",
        "last_updated": "2014-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "3443-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36084800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

Verify at the official NPI Registry.