Tracy L Wickware, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA17814 Issued in CA

Practice address

3930 4TH Ave
Suite 200
San Diego, CA 92103-3119

Phone

(619) 297-9610

Fax

(619) 297-2244

NPI assigned

Dec 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Neighborhood HealthcareGroup PAC ID 5294649406, 153 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Neighborhood Healthcare

  • Federally Qualified Health Center (FQHC)
  • Escondido, CA
  • NPI 1598703647
  Medicare reassignment Care Compare group NPD
• Neighborhood Healthcare

  • Federally Qualified Health Center (FQHC)
  • Beaumont, CA
  • NPI 1629601653
  NPD

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1417025636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 4TH AVE",
            "address_2": "SUITE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033119",
            "telephone_number": "619-297-9610",
            "fax_number": "619-297-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3930 4TH AVE",
            "address_2": "SUITE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033119",
            "telephone_number": "619-297-9610",
            "fax_number": "619-297-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKWARE",
        "first_name": "TRACY",
        "middle_name": "L",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17814",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA LICENSE",
            "identifier": "PA 17814",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shea Breenan Wickland, M.D.
• Brynne Wicklund
• Sheree Wicklund
• Austin Michele Wicks, MD
• Elizabeth Wicks
• Julianna Amy Wida, BCTMB, BS,
• Jeffrey Mark Widenhofer, LCSW
• Michelle Widjaja
• Tehya Jas Widmann
• Alyssa Wieand

• Physician Assistant in San Diego, CA
• Providers in San Diego, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.