Individual provider Active NPI

Tracy A Reese, PA-C

  • Medical Physician Assistant
  • Kalamazoo, MI
National Provider Identifier
1295824795
Registry record updated Mar 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601004897 Issued in MI
Practice address
1722 Shaffer Street
Suite 3
Kalamazoo, MI 49048
Phone
(269) 226-5197
Fax
(269) 552-0910
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601004897 MI Primary

Addresses

Primary practice location

1722 Shaffer Street
Suite 3
Kalamazoo, MI 49048

Mailing address

1722 Shaffer St.
Suite 3
Kalamazoo, MI 49048
Phone (269) 226-5197

Other identifiers 1

IdentifierTypeStateIssuer
5601004897OtherMIMICHIGAN LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070611000513 MI Practitioner - Physician Assistant 9638277940 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group PromedGroup PAC ID 7315856077, 255 clinicians

Practice addresses (Care Compare)

1722 Shaffer St
Kalamazoo, MI 49048-1633
Phone (269) 343-1555

7901 Angling Rd
Portage, MI 49024-0714

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Promed Healthcare CurrentSince Nov 22, 2011 Accepting new patients
Ascension Medical Group Promed CurrentSince Nov 22, 2011 Accepting new patients
Indiana Hospitalists, PC Past Accepting new patients
Ascension Medical Group Promed Past Accepting new patients

Locations

1722 Shaffer St
Ste 1
Kalamazoo, MI 49048
Phone (269) 381-3963

3025 Gull Rd
Kalamazoo, MI 49048
Phone (269) 343-1264

1722 Shaffer St
Ste 3
Kalamazoo, MI 49048
Phone (269) 337-6373

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

411 Naomi St
Plainwell, MI 49080
Phone (269) 685-0700

7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405

600 S Lakeview Ave
Ste 105
Sturgis, MI 49091
Phone (269) 651-9470

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678838400000",
    "number": "1295824795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1722 SHAFFER ST.",
            "address_2": "SUITE 3",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "49048",
            "telephone_number": "269-226-5197",
            "fax_number": "269-552-0910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1722 SHAFFER STREET",
            "address_2": "SUITE 3",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "49048",
            "telephone_number": "269-226-5197",
            "fax_number": "269-552-0910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REESE",
        "first_name": "TRACY",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2023-03-15",
        "certification_date": "2023-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601004897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHIGAN LICENSE",
            "identifier": "5601004897",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.