Active NPI
Joseph I. Tracy, PHD
- Clinical Neuropsychologist
- Philadelphia, PA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PS-006545-L
- Practice address
- 909 Walnut Street
Cob, 2ND Floor
Philadelphia, PA 19107-5509 - Phone
- (215) 955-1234
- Fax
- (215) 503-6792
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PS-006545-L | PA | Primary |
| Clinical Neuropsychologist | 103G00000X | SI 03245 | NJ | |
| Clinical Psychologist | 103TC0700X | PS-006545-L | PA | |
| Clinical Psychologist | 103TC0700X | SI 03245 | NJ |
Addresses
Primary practice location
909 Walnut Street
Cob, 2ND Floor
Philadelphia, PA 19107-5509
Mailing address
909 Walnut Street
Cob, 2ND Floor
Philadelphia, PA 19107-5509
Phone (215) 955-1234
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0017881100002 | Medicaid | PA | |
| 8109303 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA, NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
909 Walnut St
2ND Floor
Philadelphia, PA 19107-5211
Phone (215) 955-7000
Hospital & facility affiliations
- Thomas Jefferson University Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SI 03245 | NJ | MD | Clinical Neuropsychologist |
| PS-006545-L | PA | MD | Clinical Neuropsychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jefferson University Physicians | Current | Accepting new patients | |
| Jefferson University Physicians | Past | Accepting new patients |
Locations
925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760
615 Chestnut St
Fl 14
Philadelphia, PA 19106
Phone (215) 955-1175
4050 S 26th St
Philadelphia, PA 19112
Phone (267) 463-2284
909 Walnut St
Fl 2
Philadelphia, PA 19107
Phone (215) 955-1234
111 S 11th St
Ste 4150
Philadelphia, PA 19107
Phone (215) 955-1222
Organizations & group practices 2
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.
-
- General Practice Physician
- Philadelphia, PA
- NPI 1326093675
-
- Gastroenterology Physician
- Phila, PA
- NPI 1205898723
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Philadelphia, PA
- NPI 1215916002
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410134400000",
"number": "1386667905",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "909 WALNUT STREET",
"address_2": "COB, 2ND FLOOR",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191075509",
"telephone_number": "215-955-1234",
"fax_number": "215-503-6792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "909 WALNUT STREET",
"address_2": "COB, 2ND FLOOR",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191075509",
"telephone_number": "215-955-1234",
"fax_number": "215-503-6792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACY",
"first_name": "JOSEPH",
"middle_name": "I.",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2014-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "PA",
"license": "PS-006545-L",
"primary": true
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "NJ",
"license": "SI 03245",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS-006545-L",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NJ",
"license": "SI 03245",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0017881100002",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8109303",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2014; 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.