Tracey S Cloninger, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

103242 Issued in NC

Practice address

4201 Lake Boone TRL
Suite 200
Raleigh, NC 27607-7511

Phone

(919) 782-2152

Fax

(919) 782-7929

NPI assigned

Nov 8, 2006

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 NC

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

Brody School of Medicine at East Carolina University, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Dermatology PAGroup PAC ID 7012971609, 52 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tcloninger@aadermaffiliates.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Dermatology, P.a.

  • Specialist
  • Raleigh, NC
  • NPI 1568415586
  Medicare reassignment Care Compare group
• Carolina Skin & Vein Center Inc.

  • Dermatology Physician
  • Wilmington, NC
  • NPI 1114044682
  NPD (past)
• Anne Arundel Dermatology Affiliates PC

  • Dermatology Physician
  • Hunt Valley, MD
  • NPI 1083200794
  NPD (past)

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782345600000",
    "number": "1164592275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23329",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 LAKE BOONE TRL",
            "address_2": "SUITE 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077511",
            "telephone_number": "919-782-2152",
            "fax_number": "919-782-7929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLONINGER",
        "first_name": "TRACEY",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-08",
        "last_updated": "2026-06-25",
        "certification_date": "2026-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hailey Smith Clissold, PA-C
• Reynolds Clodfelter, Jr.
• Kerry Michelle Clodfelter, LCMHCA
• Rebecca Jeffries Cloer, FNP
• Brian Cloninger
• Kristie Reynolds Clontz, FNP-C
• Charles A Cloutier, M.D.
• Christina Clyburn, FNLP
• Clyde E. Croom, OD, PA
• CMC Transportation

• Physician Assistant in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2026; 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.