Tracy Bongiorno, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085002051 Issued in IL

Practice address

4727 Willow Springs Rd
Unit 3S
La Grange, IL 60525-6140

Phone

(708) 482-1099

Fax

(708) 482-0335

NPI assigned

May 7, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417737600000",
    "number": "1285847384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4727 WILLOW SPRINGS RD",
            "address_2": "UNIT 3S",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605256140",
            "telephone_number": "708-482-1099",
            "fax_number": "708-482-0335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4727 WILLOW SPRINGS RD",
            "address_2": "UNIT 3S",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605256140",
            "telephone_number": "708-482-1099",
            "fax_number": "708-482-0335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONGIORNO",
        "first_name": "TRACY",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2014-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085002051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beau Blakeley, DC
• Debra Babb Blakely, RN, LCPC
• Demetrios Bobolos, LAC
• Samantha Marie Boburka, PA-C
• Jerry P Bonet, D.P.M.
• Christine O'Connor Bonhomme, M.D.
• Kathryn Marie Bonnstetter
• Amy Botta
• Haley Wynne Brancheau, M.S., CCC-SLP
• Kristin Breems, LCSW

• Physician Assistant in La Grange, IL
• Providers in La Grange, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.