Traci L Bragg, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME89267 Issued in FL

Practice address

559 W Twincourt TRL Unit 601
Credentialing Department
St Augustine, FL 32095-8805

Phone

(904) 940-1441

Fax

(904) 940-1490

NPI assigned

Jun 27, 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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2016 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Mill Creek Family Care

  • Family Medicine Physician
  • St Augustine, FL
  • NPI 1255362034
  NPD (past) Authorized official
• Baptist Primary Care Inc

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1508817529
  NPD (past)

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

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1446595200000",
    "number": "1285661736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 44004",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322314004",
            "telephone_number": "904-376-3707",
            "fax_number": "904-940-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "559 W TWINCOURT TRL UNIT 601",
            "address_2": "CREDENTIALING DEPARTMENT",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320958805",
            "telephone_number": "904-940-1441",
            "fax_number": "904-940-1490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAGG",
        "first_name": "TRACI",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2015-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME89267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01113744",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "274033800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brandon Braddock, PA-C
• Thomas Martin Bradley, HIS
• Dareon Bradwell
• Kaylan Brady, M.D.
• Michael Keith Brady, PHARM.D.
• Kristina Marie Brandon, DPT
• Madison Brantley, RMHCI
• Bravery NE FL LLC (Bravery Home Healthcare)
• Britnee Breeden
• Christina Brennan, M.D.

• Family Medicine Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.