Individual provider Active NPI

Tracey Pearl, MA, CCC-SLP

  • Speech-Language Pathologist
  • Edmond, OK
National Provider Identifier
1215554738
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
1701 Signal Ridge Dr Ste 140
Edmond, OK 73013-3788
Phone
(405) 674-6304
Fax
(405) 281-0881
NPI assigned
Jun 30, 2020
Last updated
Sep 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X Primary

Addresses

Primary practice location

1701 Signal Ridge Dr Ste 140
Edmond, OK 73013-3788

Mailing address

1701 Signal Ridge Dr Ste 140
Edmond, OK 73013-3788
Phone (405) 674-6304

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221004001391 OK Practitioner - Qualified Speech Language Pathologist 4880070572 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neuro Speech Solutions, PLLCGroup PAC ID 3971989666, 3 clinicians

Practice addresses (Care Compare)

Edmond, OK 73012
Phone (405) 844-2059

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
3013OKMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Neuro Speech Solutions, PLLC Speech-Language Pathologist CurrentSince Sep 20, 2022 Accepting new patients

Locations

1701 Signal Ridge Dr
Ste 140
Edmond, OK 73013
Phone (405) 674-6304

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1593475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693958400000",
    "number": "1215554738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 SIGNAL RIDGE DR STE 140",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133788",
            "telephone_number": "405-674-6304",
            "fax_number": "405-281-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 SIGNAL RIDGE DR STE 140",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730133788",
            "telephone_number": "405-674-6304",
            "fax_number": "405-281-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARL",
        "first_name": "TRACEY",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-30",
        "last_updated": "2023-09-06",
        "certification_date": "2023-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.