John Tracy Warren, MD

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

29771-020 Issued in WI

Practice address

11 Pond View Dr
Jericho, VT 05465-2030

Phone

(920) 435-1503

NPI assigned

Jul 12, 2006

Last updated

Nov 23, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Prevea Clinic, Inc.

  • Internal Medicine Physician
  • Green Bay, WI
  • NPI 1306869276

  Family Medicine

  NPD (past)
• Prevea Regional Services, Inc.

  dba Prevea Regional

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1194748061
  NPD (past)

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669161600000",
    "number": "1407871684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 POND VIEW DR",
            "city": "JERICHO",
            "state": "VT",
            "postal_code": "054652030",
            "telephone_number": "920-246-6288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 POND VIEW DR",
            "city": "JERICHO",
            "state": "VT",
            "postal_code": "054652030",
            "telephone_number": "920-435-1503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARREN",
        "first_name": "JOHN",
        "middle_name": "TRACY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "29771",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "WI",
            "license": "29771-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31516000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Schaeffler & Associates LLC
• Scott D Simpson, LICSW
• Synergy Counseling Group, LLC
• Transitions Physical Therapy LLC
• Kristyn V Waite
• Steffani Lynn Wilson, M.S., CCC-SLP
• Sonya Worth, PT

• Geriatric Medicine (Family Medicine) Physician in Jericho, VT
• Providers in Jericho, VT by specialty
• Geriatric Medicine (Family Medicine) Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.