Active NPI
Tracy A. Penn, P.A.-C
- Medical Physician Assistant
- Brady, TX
National Provider Identifier
1083657480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA04795
- Practice address
- 2010 Nine Road
Rehab. Center Frontera Healthcare Network, Inc.
Brady, TX 76825 - Phone
- (325) 597-0102
- Fax
- (325) 597-2939
- NPI assigned
- Jun 14, 2006
- Last updated
- May 9, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA04795 | TX | Primary |
Addresses
Primary practice location
2010 Nine Road
Rehab. Center Frontera Healthcare Network, Inc.
Brady, TX 76825
Mailing address
P.O. Box 989
604 Eaker St. Frontera Healthcare Network, Inc.
Eden, TX 76837
Phone (325) 869-5500
Other names 1
- Miss Tracy Ann Crawford
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA04795 | TX | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frontera Healthcare Network | Past | Accepting new patients | |
| Hotmec, LP | Past | Accepting new patients | |
| Frontera Healthcare Network | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Federally Qualified Health Center (FQHC)
- Mason, TX
- NPI 1235381088
-
- Federally Qualified Health Center (FQHC)
- Brady, TX
- NPI 1801143664
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368057600000",
"number": "1083657480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 989",
"address_2": "604 EAKER ST. FRONTERA HEALTHCARE NETWORK, INC.",
"city": "EDEN",
"state": "TX",
"postal_code": "76837",
"telephone_number": "325-869-5500",
"fax_number": "325-869-5692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2010 NINE ROAD",
"address_2": "REHAB. CENTER FRONTERA HEALTHCARE NETWORK, INC.",
"city": "BRADY",
"state": "TX",
"postal_code": "76825",
"telephone_number": "325-597-0102",
"fax_number": "325-597-2939"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENN",
"first_name": "TRACY",
"middle_name": "A.",
"credential": "P.A.-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-14",
"last_updated": "2013-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA04795",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TRACY",
"last_name": "CRAWFORD",
"middle_name": "ANN",
"prefix": "MISS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Brady, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.