Active NPI
Andrew Marcellous Tracy, MSW
- Home Health Aide
- Henderson, NV
National Provider Identifier
1407488455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- 7854PCS3
- Practice address
- 2501 N Green Valley Pkwy Ste 118
Henderson, NV 89014-2158 - Phone
- (702) 476-8809
- NPI assigned
- Feb 7, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | 7854PCS3 | NV | Primary |
Addresses
Primary practice location
2501 N Green Valley Pkwy Ste 118
Henderson, NV 89014-2158
Mailing address
2501 N Green Valley Pkwy Ste 118
Henderson, NV 89014-2158
Phone (702) 476-8809
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7854PCS3 | NV | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702425600000",
"number": "1407488455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2501 N GREEN VALLEY PKWY STE 118",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890142158",
"telephone_number": "702-476-8809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 N GREEN VALLEY PKWY STE 118",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890142158",
"telephone_number": "702-476-8809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACY",
"first_name": "ANDREW",
"middle_name": "MARCELLOUS",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-02-07",
"last_updated": "2023-12-13",
"certification_date": "2023-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "NV",
"license": "7854PCS3",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.