Virginia Alldredge Tracey, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

295881 Issued in NY

Practice address

5824 Widewaters Pkwy Ste 4
East Syracuse, NY 13057-3072

Phone

(315) 500-7546

Fax

(315) 378-4210

NPI assigned

May 1, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Virginia Dunn Alldredge Former name

Medicare fee-for-service enrollment

Enrolled in NY

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.

Enrollment records 1

Specialty

Dermatology

Education

Tulane University School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Magnolia Dermatology, PLLCGroup PAC ID 8123560679, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Magnolia Dermatology, PLLC

  • Dermatology Physician
  • Latham, NY
  • NPI 1932889102
  Medicare reassignment Care Compare group NPD Authorized official
• Imperium Healthcare Consulting LLC

  • Durable Medical Equipment & Medical Supplies
  • East Syracuse, NY
  • NPI 1184335887
  NPD (past)

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

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1336584523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5824 WIDEWATERS PKWY STE 4",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130573072",
            "telephone_number": "315-500-7546",
            "fax_number": "315-378-4210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5824 WIDEWATERS PKWY STE 4",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130573072",
            "telephone_number": "315-500-7546",
            "fax_number": "315-378-4210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRACEY",
        "first_name": "VIRGINIA",
        "middle_name": "ALLDREDGE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-05-01",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "295881",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICENSE",
            "identifier": "295881",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIRGINIA",
            "last_name": "ALLDREDGE",
            "middle_name": "DUNN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Catherine Marie Tomaiuoli, ANP-C
• Thomas Tormey
• David Brian Torrales, O.D.
• Giovanni E Torres, M.A
• Megan Cleary Toumbacaris, M.S., CCC-SLP
• Tri-County Home Care Services LLC
• Girish Trikha, M.D.
• Suzette M Trovato, NP
• Tsa Physical Therapy PC
• Hillary Tupper, RPA

• Dermatology Physician in East Syracuse, NY
• Providers in East Syracuse, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; 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.