NPIMap

Individual provider Active NPI

Tracy Ann Roberts, DNP, NP-C

  • Family Nurse Practitioner
  • Meridian, ID
National Provider Identifier
1396369138
Registry record updated Feb 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
65132 Issued in ID
Practice address
4740 N Penngrove Way Ste 100
Meridian, ID 83646-7446
Phone
(208) 938-3663
Fax
(208) 938-3664
NPI assigned
Jun 6, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 9, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 51644 ID
Family Nurse Practitioner 363LF0000X 65132 ID Primary

Addresses

Primary practice location

4740 N Penngrove Way Ste 100
Meridian, ID 83646-7446

Mailing address

4740 N Penngrove Way Ste 100
Meridian, ID 83646-7446
Phone (208) 938-3663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20200803002361 ID Practitioner - Nurse Practitioner 2365860178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pioneer Family Medicine PLLCGroup PAC ID 5193877850, 13 clinicians

Practice addresses (Care Compare)

4740 N Penngrove Way
Suite 100
Meridian, ID 83646-7446
Phone (208) 938-3663

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
65132IDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Family Medicine PLLC CurrentSince Aug 1, 2020 Accepting new patients

Locations

4740 N Penngrove Way
Ste 100
Meridian, ID 83646
Phone (208) 938-3663

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FBBGCA

Organizations & group practices 1

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.

Hospital & facility affiliations 9

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": "1591401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1396369138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4740 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467446",
            "telephone_number": "208-938-3663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4740 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467446",
            "telephone_number": "208-938-3663",
            "fax_number": "208-938-3664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "TRACY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DNP, NP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-06",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "51644",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "65132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.