NPIMap

Individual provider Active NPI

Tracy Lynn Gosen Clary, M.D.

  • Obstetrics & Gynecology Physician
  • Maple Grove, MN
National Provider Identifier
1396034856
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
61848 Issued in MN
Practice address
9855 Hospital Dr
Maple Grove, MN 55369-4648
Phone
(952) 993-3282
NPI assigned
Apr 5, 2011
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MT199407 PA
Obstetrics & Gynecology Physician 207V00000X MD449471 PA
Obstetrics & Gynecology Physician 207V00000X 61848 MN Primary

Addresses

Primary practice location

9855 Hospital Dr
Maple Grove, MN 55369-4648

Mailing address

1350 Locust St
Suite 301
Pittsburgh, PA 15219-4738
Phone (412) 471-4488

Other practice location 1

1350 Locust St
Suite 301
Pittsburgh, PA 15219-4738
Phone (412) 471-4488

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170623001757 MN Practitioner - Obstetrics/Gynecology 7719291657 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians

Practice addresses (Care Compare)

9855 Hospital Dr
Maple Grove, MN 55369-4648
Phone (952) 993-4913

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
61848MNMDObstetrics & Gynecology Physician
MT199407PAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic Obstetrics & Gynecology CurrentSince Jul 31, 2017 Accepting new patients
Park Nicollet Clinic Obstetrics & Gynecology CurrentSince Jul 31, 2017 Accepting new patients
Maple Grove Hospital Corporation Past Accepting new patients

Locations

9855 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-5800

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

4155 County Road 101 N
Plymouth, MN 55446
Phone (952) 977-3000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1396034856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 LOCUST ST",
            "address_2": "SUITE 301",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152194738",
            "telephone_number": "412-471-4488",
            "fax_number": "412-641-6834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9855 HOSPITAL DR",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694648",
            "telephone_number": "952-993-3282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1350 Locust St",
            "address_2": "Suite 301",
            "address_purpose": "LOCATION",
            "city": "Pittsburgh",
            "state": "PA",
            "postal_code": "152194738",
            "country_code": "US",
            "telephone_number": "412-471-4488",
            "fax_number": "412-641-6834",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARY",
        "first_name": "TRACY",
        "middle_name": "LYNN GOSEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "MT199407",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "MD449471",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "61848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.