Individual provider Active NPI

Tracy Ruth Gallagher, CPNP

  • Pediatric Nurse Practitioner
  • Hammond, LA
National Provider Identifier
1396888970
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
APO5128 Issued in LA
Practice address
19100 Dr John Lambert Dr
Hammond, LA 70403-0922
Phone
(985) 247-4567
Fax
(985) 467-0896
NPI assigned
Feb 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X APO5128 LA Primary

Addresses

Primary practice location

19100 Dr John Lambert Dr
Hammond, LA 70403-0922

Mailing address

38085 Highway 621
Gonzales, LA 70737-6052
Phone (225) 252-5644

Other identifiers 1

IdentifierTypeStateIssuer
1004529MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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

Enrollment IDStateProvider typePAC IDDetails
I20070423000513 LA Practitioner - Nurse Practitioner 7113022948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Diabetes Care Solution, LLCGroup PAC ID 1759546260, 4 clinicians

Practice addresses (Care Compare)

19100 Dr John Lambert Dr
Hammond, LA 70403-0922
Phone 9852474567204

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APO5128LAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Convenient Care LLC CurrentSince Apr 15, 2016 Accepting new patients
Convenient Care LLC Current Accepting new patients
Convenient Care LLC CurrentSince Apr 15, 2016 Accepting new patients
Family Healthcare of Loranger, LLC CurrentSince Dec 25, 2020 Accepting new patients
Professional Emergency Physician Associates, LLC Past Accepting new patients
Diabetes Care Solution, LLC Past Accepting new patients

Locations

12525 Perkins Rd
#B
Baton Rouge, LA 70810
Phone (225) 819-8857

54002 Highway 1062
Loranger, LA 70446
Phone (985) 606-2273

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1396888970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38085 HIGHWAY 621",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707376052",
            "telephone_number": "225-252-5644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19100 DR JOHN LAMBERT DR",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704030922",
            "telephone_number": "985-247-4567",
            "fax_number": "985-467-0896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLAGHER",
        "first_name": "TRACY",
        "middle_name": "RUTH",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-14",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "LA",
            "license": "APO5128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004529",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hammond, LA

Sources for this page

Verify at the official NPI Registry.