Tracy E Bunnell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12367 Issued in MN

Practice address

5803 Neal Ave N
Oak Park Heights, MN 55082-2177

Phone

(651) 439-8807

Fax

(651) 439-0232

NPI assigned

Aug 17, 2015

Last updated

Nov 29, 2017By 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 3

Addresses

Other identifiers 1

Other names 1

• Tracy E Weigel Former name

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tria Orthopaedic Center LLCGroup PAC ID 3173570561, 504 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lakeview Memorial Hospital Hospital, Stillwater, MN, CCN 240066

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Tria Orthopaedic Center LLC

  dba TRIA Orthopaedic Clinic

  • Orthopaedic Surgery Physician
  • Bloomington, MN
  • NPI 1518273085
  Medicare reassignment Care Compare group
• Lakeview Memorial Hospital Association Inc

  dba Lakeview Hospital

  • General Acute Care Hospital
  • Stillwater, MN
  • NPI 1538138003
  NPD (past)
• Lakeview Memorial Hospital Association Inc.

  • Neonatal Nurse Practitioner
  • Stillwater, MN
  • NPI 1821114729
  NPD (past)
• Hudson Hospital, Inc

  dba Hudson Hospital & Clinics

  • Clinic/Center
  • Hudson, WI
  • NPI 1184685190
  NPD (past)
• Infinite Health Collaborative, PA

  • Durable Medical Equipment & Medical Supplies
  • River Falls, WI
  • NPI 1144608589
  NPD (past)

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

• Lakeview Memorial Hospital Association Inc

  dba Lakeview Hospital

  • General Acute Care Hospital
  • Stillwater, MN
  • NPI 1538138003
  Care Compare affiliation
• Lakeview Memorial Hospital Association Inc

  • Land Ambulance
  • Stillwater, MN
  • NPI 1730213653

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1439769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511913600000",
    "number": "1134595978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5803 NEAL AVE N",
            "city": "OAK PARK HEIGHTS",
            "state": "MN",
            "postal_code": "550822177",
            "telephone_number": "651-439-8807",
            "fax_number": "651-439-0232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5803 NEAL AVE N",
            "city": "OAK PARK HEIGHTS",
            "state": "MN",
            "postal_code": "550822177",
            "telephone_number": "651-439-8807",
            "fax_number": "651-439-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNNELL",
        "first_name": "TRACY",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-17",
        "last_updated": "2017-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3974",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "PAC0616",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "12367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134595978",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "WEIGEL",
            "middle_name": "E",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bruce J Bartie, D.O.
• Aaron Benson, A.T.C.
• Virginia Cook Borrman, PT
• Austin A Boyer, DPT
• George P. Boyum, M.D.
• Emily Jean Campbell, DNP, APRN, PMHNP-BC
• Gregg A Carlton, PHARM D
• Thomas Jason Cesarz, M.D.
• Chepulis Family Eye Care, Inc.
• Glenn Warren Ciegler, MD

• Physician Assistant in Oak Park Heights, MN
• Providers in Oak Park Heights, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2017; 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.