NPIMap

Individual provider Active NPI

Tracey Kathleen Tracy, MD

  • Family Medicine Physician
  • La Grande, OR
National Provider Identifier
1073760955
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD151037 Issued in OR
Practice address
506 4TH St
La Grande, OR 97850
Phone
(541) 663-3138
Fax
(541) 975-5120
NPI assigned
Aug 22, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD151037 OR Primary
Family Medicine Physician 207Q00000X MD60747878 WA

Addresses

Primary practice location

506 4TH St
La Grande, OR 97850

Mailing address

506 4TH St
La Grande, OR 97850-1906
Phone (541) 663-3138

Other identifiers 2

IdentifierTypeStateIssuer
500620109MedicaidOR
P00965892OtherORRR MEDICARE

Other names 1

  • Tracey Kathleen Hanrahan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, SD2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101102001013 OR Practitioner - Family Practice 9739373887 Reassigns benefits to 2 organizations
I20230908002667 SD Practitioner - Family Practice 9739373887 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oregon Health Sciences University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monument Health Network IncGroup PAC ID 5991616427, 163 clinicians
Monument Health Rapid City Hospital IncGroup PAC ID 6002729506, 560 clinicians

Practice addresses (Care Compare)

1420 N 10TH St
Spearfish, SD 57783-1532
Phone (605) 717-8595

640 Flormann St
Rapid City, SD 57701-4679
Phone (605) 755-3300

Hospital & facility affiliations

  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077
  • Monument Health Spearfish Hospital Hospital, Spearfish, SD, CCN 430048

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD60747878WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Rapid City Hospital, Inc Current Accepting new patients
Monument Health Network, Inc. CurrentSince Feb 26, 2025 Accepting new patients
Monument Health Network, Inc. Family Medicine CurrentSince Feb 26, 2025 Accepting new patients
Monument Health Rapid City Hospital Inc CurrentSince Aug 1, 2023 Accepting new patients
Monument Health Rapid City Hospital, Inc. CurrentSince Aug 1, 2023 Accepting new patients
Monument Health Network, Inc. Current Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Feb 28, 2014 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Feb 28, 2014 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Family Medicine Current Accepting new patients
Monument Health Rapid City Hospital, Inc. Past Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

2116 Jackson Blvd
Rapid City, SD 57702
Phone (605) 755-3300

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

640 Flormann St
Rapid City, SD 57701
Phone (605) 341-3140

1420 N 10th St
Spearfish, SD 57783
Phone (605) 642-8414

1440 N Main St
Spearfish, SD 57783
Phone (605) 644-4000

Interoperability endpoints

  • Direct secure messaging: thanrahan103783@wm.providencedirect.org
  • Direct secure messaging: ttracy.134140@regionalhealth.sdhealthlink.net

Organizations & group practices 11

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1073760955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501906",
            "telephone_number": "541-663-3138",
            "fax_number": "541-975-5120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "97850",
            "telephone_number": "541-663-3138",
            "fax_number": "541-975-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRACY",
        "first_name": "TRACEY",
        "middle_name": "KATHLEEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-22",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD151037",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60747878",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500620109",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00965892",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "HANRAHAN",
            "middle_name": "KATHLEEN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in La Grande, OR

Sources for this page

Verify at the official NPI Registry.