Individual provider Active NPI

Tracy Democker Fennessy, MD

  • Emergency Medicine Physician
  • Nashville, TN
National Provider Identifier
1174055933
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
59933 Issued in TN
Practice address
3601 The Vanderbilt Clinic
Nashville, TN 37232-4700
Phone
(615) 322-3000
NPI assigned
Mar 31, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 59933 TN Primary

Addresses

Primary practice location

3601 The Vanderbilt Clinic
Nashville, TN 37232-4700

Mailing address

719 Thompson LN Ste 30330
Nashville, TN 37204-4701
Phone (615) 322-3000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tfennessy22565@direct.vumc.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210512001568 DC Practitioner - Emergency Medicine 8921429028 Reassigns benefits to 2 organizations
I20210929001511 VA Practitioner - Emergency Medicine 8921429028 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Virginia Commonwealth University, School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Commonwealth Emergency Physicians PCGroup PAC ID 7618870312, 44 clinicians

Practice addresses (Care Compare)

2501 Parkers LN
Alexandria, VA 22306-3209
Phone (703) 664-7000

Hospital & facility affiliations

  • Inova Loudoun Hospital Hospital, Leesburg, VA, CCN 490043

Merit-based Incentive Payment System (MIPS)

Final score
91.67 of 100Reported as group
Quality
90.2
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
59933TNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Emergency Physicians PC Emergency Medicine CurrentSince Sep 1, 2021 Accepting new patients
Virginia Emergency Medicine Assoicates, LTD CurrentSince Jan 22, 2022 Accepting new patients
Fair Oaks Emergency Physicians, PLLC CurrentSince May 1, 2021 Accepting new patients
Commonwealth Emergency Physicians PC PastSince Apr 17, 2020 Accepting new patients

Locations

2501 Parkers Ln
Alexandria, VA 22306
Phone (703) 664-7000

22505 Landmark Ct
Ashburn, VA 20148
Phone (571) 472-6464

3600 Joseph Siewick Dr
Fairfax, VA 22033
Phone (703) 391-3037

44045 Riverside Pkwy
Leesburg, VA 20176
Phone (703) 858-6040

224 Cornwall St NW
Leesburg, VA 20176
Phone (703) 771-2894

500 Hospital Dr
Warrenton, VA 20186
Phone (540) 316-5000

Interoperability endpoints

  • Direct secure messaging: tfennessy22565@direct.vumc.org

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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": "1490918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1174055933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 THOMPSON LN STE 30330",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372044701",
            "telephone_number": "615-322-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 THE VANDERBILT CLINIC",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372324700",
            "telephone_number": "615-322-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNESSY",
        "first_name": "TRACY",
        "middle_name": "DEMOCKER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-31",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "59933",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tfennessy22565@direct.vumc.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Health Information Service Provider",
            "address_1": "3601 The Vanderbilt Clinic",
            "city": "Nashville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "372324700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

Verify at the official NPI Registry.