Active NPI
Kevin Abraham Tracy, MD
- Pediatrics Physician
- Sacramento, CA
National Provider Identifier
1215919550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G55177
- Practice address
- 2521 Stockton Blvd
Glassrock BLDG. Suite 4100
Sacramento, CA 95817-2207 - Phone
- (916) 734-5846
- NPI assigned
- Nov 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G55177 | CA | Primary |
Addresses
Primary practice location
2521 Stockton Blvd
Glassrock BLDG. Suite 4100
Sacramento, CA 95817-2207
Mailing address
9555 Cedar Rail Way
Elk Grove, CA 95624-6016
Phone (916) 714-7677
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G551770 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G55177 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1215919550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9555 CEDAR RAIL WAY",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "956246016",
"telephone_number": "916-714-7677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2521 STOCKTON BLVD",
"address_2": "GLASSROCK BLDG. SUITE 4100",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958172207",
"telephone_number": "916-734-5846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACY",
"first_name": "KEVIN",
"middle_name": "ABRAHAM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-14",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G55177",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G551770",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.