Abigail Jean Tracy, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

14165 Issued in MN

Practice address

4480 Centerville Rd
White Bear Lake, MN 55127

Phone

(651) 484-2724

Fax

(651) 484-2723

NPI assigned

Mar 9, 2021

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

Other names 1

• Abigail Jean Lange Former name

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

Physician Assistant

Education

Des Moines University of Osteopathic Medicine and Health Sciences, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

United Skin Specialists LTDGroup PAC ID 0446558993, 15 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

74.85 of 100Reported as group

Quality

70.56

Promoting interoperability

81

Improvement activities

40

Cost

61.43

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: abigail.tracy@schweigerderm.emadirect.md
• Direct secure messaging: abigaill@adc.emadirect.md

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.

• United Skin Specialists, LTD PC

  • Procedural Dermatology Physician
  • Edina, MN
  • NPI 1861861759
  Medicare reassignment Care Compare group
• Southwest Dermatology Specialists. LTD

  • Dermatology Physician
  • Richfield, MN
  • NPI 1205960317
  NPD
• Skin Specialists, LTD.

  • Dermatology Physician
  • Minneapolis, MN
  • NPI 1013921600
  NPD (past)

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

{
    "created_epoch": "1615248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1336724590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4480 CENTERVILLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "55127",
            "telephone_number": "651-484-2724",
            "fax_number": "651-484-2723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4480 CENTERVILLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "55127",
            "telephone_number": "651-484-2724",
            "fax_number": "651-484-2723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRACY",
        "first_name": "ABIGAIL",
        "middle_name": "JEAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-09",
        "last_updated": "2024-01-19",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ABIGAIL",
            "last_name": "LANGE",
            "middle_name": "JEAN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physician Assistant in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; 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.