Wallace Lee Tracy, M.D.
Individual provider Active NPI Family Medicine Physician · De Witt, AR
NPI 1366438384 · NPPES record last updated Mar 5, 2026
Key facts
- NPI
- 1366438384
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- C7340 (AR)
- Practice address
- 1940 S Whitehead Dr
De Witt, AR 72042-2906 - Phone
- (870) 946-4505
- Fax
- (870) 946-2428
- NPI assigned
- Sep 26, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Arkansas College of Medicine, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dewitt Hospital and Nursing Home Inc
Mid-Delta Health Systems Inc
Practice addresses (Care Compare)
1641 S Whitehead Dr
De Witt, AR 72042-2994
Phone (870) 946-3571
1940 S Whitehead Dr
Mid Delta Health Systems de Witt
De Witt, AR 72042-1543
Phone (870) 946-4505
Hospital & facility affiliations
- Dewitt Hospital & Nursing Home, Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100924001157 | AR | Practitioner - Family Practice | 3274659495 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C7340 | AR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mid-Delta Health Systems, Inc. | Current |
Accepting new patients | |
| Mid-Delta Health Systems Inc | Current |
Accepting new patients | |
| Dewitt Hospital & Nursing Home, Inc. | Current |
Accepting new patients | |
| Mid-Delta Health Systems, Inc. | Past | Accepting new patients |
Locations
401 Midland St
Clarendon, AR 72029
Phone (870) 474-3381
1117 Eason Rd
Clarendon, AR 72029
Phone (870) 201-2135
245 Madison St
Clarendon, AR 72029
Phone (870) 747-1400
1940 S Whitehead Dr
Dewitt, AR 72042
Phone (870) 946-4505
1641 S Whitehead Dr
Dewitt, AR 72042
Phone (870) 946-2971
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C7340 | AR | Yes |
Addresses
Primary practice location
1940 S Whitehead Dr
De Witt, AR 72042-2906
Mailing address
245 Madison St
Clarendon, AR 72029-2706
Phone (870) 747-1400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 114942001 | Medicaid | AR |
Other providers in De Witt, AR
- Stan W Burleson MD PA
- Abby Staton
- Stephen Lloyd Stewart
- Tommys Rexall Drug Company Inc
- Tracy Family Practice Clinic PA
- Van M Dunn
- Howard Dean Watts
- Karen Watts
- West Haven Village, LLC
- West Point LLC
All providers in De Witt, AR · Family Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.