NPIMap

Individual provider Active NPI

Traci Specht

  • Family Nurse Practitioner
  • Grand Forks, ND
National Provider Identifier
1144908625
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R31830 Issued in ND
Practice address
2100 S Columbia Rd Ste 114
Grand Forks, ND 58201-5895
Phone
(701) 516-4637
Fax
(877) 651-1381
NPI assigned
Jul 6, 2023
Last updated
Feb 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R31830 ND Primary

Addresses

Primary practice location

2100 S Columbia Rd Ste 114
Grand Forks, ND 58201-5895

Mailing address

PO Box 13238
Grand Forks, ND 58208-3238
Phone (701) 516-4637

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230808000181 ND Practitioner - Nurse Practitioner 0648631622 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Medical LLCGroup PAC ID 0648698290, 18 clinicians

Practice addresses (Care Compare)

800 16TH Ave SE
Minot, ND 58701-6781
Phone (701) 516-4637

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.05 of 100Reported as group
Quality
60.57
Promoting interoperability
98
Improvement activities
40
Cost
77.93

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R31830NDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Primary Care PLLC CurrentSince Dec 1, 2024 Accepting new patients
Legacy Medical LLC CurrentSince Dec 1, 2024 Accepting new patients

Locations

600 S 2nd St
Ste 200
Bismarck, ND 58504
Phone (701) 757-5463

2100 S Columbia Rd
Ste 114
Grand Forks, ND 58201
Phone (701) 757-2225

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JCIBCD

Organizations & group practices 2

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1688601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739750400000",
    "number": "1144908625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13238",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582083238",
            "telephone_number": "701-516-4637",
            "fax_number": "877-651-1381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S COLUMBIA RD STE 114",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015895",
            "telephone_number": "701-516-4637",
            "fax_number": "877-651-1381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPECHT",
        "first_name": "TRACI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-06",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "R31830",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.