Individual provider Active NPI

Tracy Owusu, FNP-BC

  • Family Nurse Practitioner
  • New York, NY
National Provider Identifier
1417711706
Registry record updated Feb 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
635410-1 Issued in NY
Practice address
1320 York Ave
New York, NY 10021-4800
Phone
(917) 353-6149
NPI assigned
Feb 8, 2024
Last updated
Feb 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 25, 2024

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 635410-1 NY Primary
Family Nurse Practitioner 363LF0000X 353718 NY

Addresses

Primary practice location

1320 York Ave
New York, NY 10021-4800

Mailing address

1320 York Ave
New York, NY 10021-4800
Phone (917) 353-6149

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20240426000084 NY Practitioner - Nurse Practitioner 6204276173 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Starling Diagnostics LLCGroup PAC ID 6800224759, 19 clinicians

Practice addresses (Care Compare)

1480 E Ave
Bronx, NY 10462-7502
Phone (973) 713-8623

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
353718NYMDFamily Nurse Practitioner
635410-1NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Starling Diagnostics LLC CurrentSince Mar 18, 2024 Accepting new patients
California Medical Imaging Associates, Inc PastSince Jan 1, 2021 Accepting new patients

Locations

1480 East Ave
Bronx, NY 10462
Phone (718) 319-1610

Interoperability endpoints

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

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1707350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708819200000",
    "number": "1417711706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 YORK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214800",
            "telephone_number": "917-353-6149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 YORK AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214800",
            "telephone_number": "917-353-6149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWUSU",
        "first_name": "TRACY",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-08",
        "last_updated": "2024-02-25",
        "certification_date": "2024-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "635410-1",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "353718",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.