Tracy L. Harris

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

550000104 Issued in CA

Practice address

3914 Murphy Canyon Rd
Suite# A226
San Diego, CA 92123-4491

Phone

(858) 751-0315

NPI assigned

Aug 31, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN 051791

Legal name

TRACY L HARRIS

Doing business as

AVALON HOSPICE & PALLIATIVE CARE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Apr 3, 2006

Last certification

Mar 23, 2018

Ownership / control type

Proprietary - Individual

Organization structure

Sole ProprietorProprietary

Enrollment address

3914 Murphy Canyon Rd
Ste A226
San Diego, CA 92123-4436

Listed as

Avalon Hospice & Palliative CareCCN 051791

Ownership

For-Profit

Certified

Apr 3, 2006

Medicare certification status

ActiveFrom the Provider of Services file

Medicare enrollment (NPD)

Not enrolled

State licenses

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Claudio V Zawitkowski, M.D.,

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1578558623

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1346371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347235200000",
    "number": "1154670404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3914 MURPHY CANYON RD",
            "address_2": "SUITE# A226",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234491",
            "telephone_number": "858-751-0315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3914 MURPHY CANYON RD",
            "address_2": "SUITE# A226",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234491",
            "telephone_number": "858-751-0315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "TRACY",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-31",
        "last_updated": "2012-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": "550000104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DBA  -  AVALON HOSPICE & PALLIATIVE CARE",
            "identifier": "550000104",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HPC01791F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Teresa Liu Harris, MS, NP
• Thomas William Harris, M.D.
• Tia Ja'Neec Harris
• Tianna Harris, ASW
• Tiffani Harris
• Travisia Jonette Harris, LVN
• Trina Harris
• Vanessa Harris, BCABA
• Victoria Jaravata Harris
• Ani Harrison, M.A.

• Community Based Hospice Care Agency in San Diego, CA
• Providers in San Diego, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.