Active NPI
Tracy Miracle, LMSW
- Social Worker
- Wichita, KS
National Provider Identifier
1114668191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 12283
- Practice address
- 1005 S Glendale St
Wichita, KS 67218-3203 - Phone
- (316) 771-7315
- NPI assigned
- Apr 5, 2022
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 12283 | KS | Primary |
Addresses
Primary practice location
1005 S Glendale St
Wichita, KS 67218-3203
Mailing address
1005 S Glendale St
Wichita, KS 67218-3203
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12283 | Other | KS | BSRB |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12283 | KS | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649116800000",
"number": "1114668191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1005 S GLENDALE ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672183203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1005 S GLENDALE ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672183203",
"telephone_number": "316-771-7315"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRACLE",
"first_name": "TRACY",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-05",
"last_updated": "2022-04-05",
"certification_date": "2022-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "KS",
"license": "12283",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BSRB",
"identifier": "12283",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.