NPIMap

Individual provider Active NPI

Kelly Lee Tracey, D.O.

  • General Practice Physician
  • Prescott, AZ
National Provider Identifier
1255441143
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
20A11995 Issued in CA
Practice address
3124 Willow Creek Rd
Prescott, AZ 86301-6610
Phone
(923) 445-7085
Fax
(928) 433-0730
NPI assigned
Aug 30, 2006
Last updated
Apr 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 3595 AZ
General Practice Physician 208D00000X 20A11995 CA Primary

Addresses

Primary practice location

3124 Willow Creek Rd
Prescott, AZ 86301-6610

Mailing address

81 W Guadalupe Rd Ste 111
Gilbert, AZ 85233-3321
Phone (480) 366-4490

Other identifiers 1

IdentifierTypeStateIssuer
776940MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040712001214 AZ Practitioner - General PracticePractitioner - Family Practice 2961486113 Reassigns benefits to 1 organization
I20140319001520 CA Practitioner - Family Practice 2961486113 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Oklahoma State University College of Osteopathic Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Davis OrthopaedicsGroup PAC ID 0749506269, 7 clinicians

Practice addresses (Care Compare)

3221 N Windsong Dr
Prescott Valley, AZ 86314-1222
Phone (928) 910-7010

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A11995CAMDGeneral Practice Physician
3595AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Foundation Medical Group CurrentSince Nov 1, 2014 Accepting new patients
Mendocino Community Health Clinic, Inc. CurrentSince Dec 18, 2022 Accepting new patients
Community Foundation Medical Group CurrentSince Nov 1, 2014 Accepting new patients
Mendocino Community Health Clinic, Inc. Current Accepting new patients
Preferred Health Management Corporation CurrentSince Jan 30, 2013 Accepting new patients
Mendocino Community Health Clinic, Inc. CurrentSince Dec 18, 2022 Accepting new patients
Community Foundation Medical Group Current Accepting new patients
Davis Orthopaedics General Practice CurrentSince May 1, 2025 Accepting new patients
G & J Roth Professional Corp PastSince Feb 10, 2014 Accepting new patients
Honorhealth Medical Group, LLC Past Accepting new patients
Voytek Inc PastSince Jul 1, 2021 Accepting new patients
Mountain View Family Practice Past Accepting new patients

Locations

3221 N Windsong Dr
Prescott Vly, AZ 86314
Phone (928) 772-5320

3237 N Windsong Dr
Prescott Vly, AZ 86314
Phone (602) 680-0236

8575 E Princess Dr
Ste 107
Scottsdale, AZ 85255
Phone (480) 513-9500

2335 E Kashian Ln
Ste 270
Fresno, CA 93701
Phone (559) 445-1251

333 Laws Ave
Ukiah, CA 95482
Phone (707) 463-1113

37300 Dequindre Rd
Ste 112
Sterling Hts, MI 48310
Phone (586) 825-2313

Organizations & group practices 12

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.

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1255441143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 W GUADALUPE RD STE 111",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852333321",
            "telephone_number": "480-366-4490",
            "fax_number": "480-854-3618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3124 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863016610",
            "telephone_number": "923-445-7085",
            "fax_number": "928-433-0730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRACEY",
        "first_name": "KELLY",
        "middle_name": "LEE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AZ",
            "license": "3595",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "20A11995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "776940",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott, AZ

Sources for this page

Verify at the official NPI Registry.