Tracy Ann Merriam, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3420 Issued in OR

Practice address

110 10TH St SE
Bandon, OR 97411-9157

Phone

(541) 347-5191

Fax

(541) 266-4578

NPI assigned

Feb 26, 2022

Last updated

Jun 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Bend Medical Center IncGroup PAC ID 5597677716, 92 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• North Bend Medical Center Inc

  dba NBMC-Main

  • Multi-Specialty Clinic/Center
  • Coos Bay, OR
  • NPI 1407812365
  Medicare reassignment Care Compare group NPD
• Bandon Community Health Center

  • Primary Care Clinic/Center
  • Bandon, OR
  • NPI 1033348289
  Medicare reassignment NPD
• Bandon Community Health Ctr

  dba Coast Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Port Orford, OR
  • NPI 1013587484
  NPD
• North Bend Medical Center Inc

  dba NBMC-Xray Ekg

  • Diagnostic Radiology Physician
  • Coos Bay, OR
  • NPI 1063428308
  NPD

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

{
    "created_epoch": "1645833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1104572288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202099",
            "telephone_number": "541-267-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 10TH ST SE",
            "city": "BANDON",
            "state": "OR",
            "postal_code": "974119157",
            "telephone_number": "541-347-5191",
            "fax_number": "541-266-4578"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Woodland Dr",
            "address_purpose": "LOCATION",
            "city": "Coos Bay",
            "state": "OR",
            "postal_code": "974202099",
            "country_code": "US",
            "telephone_number": "541-267-5151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MERRIAM",
        "first_name": "TRACY",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-26",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "3420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danelle Legault, RPH
• Juanell Lemon, L.M.T.
• Rachelle Marmor, L.AC
• Gail K McClave, MD
• Holly E McKenzie
• Holly J Mousa, PHARMD
• Andrew J Oas, DMD
• Karen Jane Olson, CFNP-APRN
• Oregon Retina, LLP
• Pacific Sleep & Respiratory Diagnostics LLC

• Clinical Social Worker in Bandon, OR
• Providers in Bandon, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.