Katlyn Ashley Tracy

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

405 Baker St
San Francisco, CA 94117-1403

Phone

(415) 861-0828

Fax

(415) 861-0140

NPI assigned

Jan 27, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Bonita House, Inc.

  • Community/Behavioral Health Agency
  • Berkeley, CA
  • NPI 1811559735
  NPD
• Bonita House, Inc.

  • Community/Behavioral Health Agency
  • Oakland, CA
  • NPI 1902253016
  NPD (past)

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

{
    "created_epoch": "1580083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1326679556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "368 FELL ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941025144",
            "telephone_number": "415-861-0828",
            "fax_number": "415-861-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 BAKER ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941171403",
            "telephone_number": "415-861-0828",
            "fax_number": "415-861-0140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1909 University Ave",
            "address_purpose": "LOCATION",
            "city": "Berkeley",
            "state": "CA",
            "postal_code": "947041023",
            "country_code": "US",
            "telephone_number": "510-809-3004",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRACY",
        "first_name": "KATLYN",
        "middle_name": "ASHLEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-27",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053526715",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://bonitahouse.org/berkeley-creative-wellness-center-cwc/",
            "affiliation": "Y",
            "endpointDescription": "Website URL",
            "affiliationName": "Bonita House, Inc.",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "n/a",
            "address_1": "1909 University Ave",
            "city": "Berkeley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "947041023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Colin Gerard Trachsel, NP
• Pete Trachy, RN
• Norine Patricia Traci-Maloney
• Tracy McGillis Family Therapy PC
• Jessica Kelly Tracy, LMFT
• Janna Traeger, NP
• Joseph Michael Tragesser
• Mary Elizabeth Trail, MFT
• Michael Scott Trainer, MD
• Marshall Trammell

• Community Health Worker in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.