Tracy Gilmore, M.S.W., L.C.S.W.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.013322 Issued in IL

Practice address

478 SW Douglas St
Mill City, OR 97360-0009

Phone

(773) 332-3058

NPI assigned

May 21, 2007

Last updated

Jan 12, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mindful Therapy Group PC

  dba Mindful Therapy Group

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678

  OR

  Medicare reassignment Care Compare group NPD
• Juvenile Protective Association

  • Community/Behavioral Health Agency
  • Chicago, IL
  • NPI 1023559705
  Authorized official Same address or phone

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1295944791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "478 SW DOUGLAS ST # 23",
            "city": "MILL CITY",
            "state": "OR",
            "postal_code": "973600009",
            "telephone_number": "773-332-3058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "478 SW DOUGLAS ST",
            "city": "MILL CITY",
            "state": "OR",
            "postal_code": "973600009",
            "telephone_number": "773-332-3058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILMORE",
        "first_name": "TRACY",
        "name_prefix": "Ms.",
        "credential": "M.S.W., L.C.S.W.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L10223",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.013322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrrie B Bandtel, FNP
• Justin Brunson, PSS
• Care Bridge LLC
• Emily Conley, PHARMD
• Kathleen Susanne Gamble, THW, PSS
• Lynn Eleanor-Johnson Gower, DO
• Johannah Marie Gregg, FNP-C
• Jessica Leigh Grim, FNP
• Christopher Kargel, DO, MPH
• Jerry Korkow, PSS

• Clinical Social Worker in Mill City, OR
• Providers in Mill City, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.