Individual provider Active NPI

Tracy Lynn Delong, FNP

  • Nurse Practitioner
  • Costa Mesa, CA
National Provider Identifier
1427772748
Registry record updated Nov 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
95022889 Issued in CA
Practice address
275 Victoria St Ste 2K
Costa Mesa, CA 92627-1906
Phone
(949) 646-1631
NPI assigned
Sep 29, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 537375 CA
Nurse Practitioner 363L00000X 95022889 CA Primary

Addresses

Primary practice location

275 Victoria St Ste 2K
Costa Mesa, CA 92627-1906

Mailing address

275 Victoria St Ste 2K
Costa Mesa, CA 92627-1906
Phone (949) 646-1631

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://memorialcare.org/fhir/api/FHIR/R4/ Health Information Exchange (HIE) MemorialCare Medical Foundation

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240905003553 CA Practitioner - Nurse Practitioner 0143760017 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
537375CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation Nurse Practitioner CurrentSince Jul 22, 2024 Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

18102 Culver Dr
Irvine, CA 92612
Phone (657) 241-8220

Organizations & group practices 1

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": "1664409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732752000000",
    "number": "1427772748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 VICTORIA ST STE 2K",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926271906",
            "telephone_number": "949-646-1631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 VICTORIA ST STE 2K",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926271906",
            "telephone_number": "949-646-1631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELONG",
        "first_name": "TRACY",
        "middle_name": "LYNN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-29",
        "last_updated": "2024-11-28",
        "certification_date": "2024-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "537375",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95022889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://memorialcare.org/fhir/api/FHIR/R4/",
            "affiliation": "Y",
            "endpointDescription": "MemorialCare FHIR Endpoint",
            "affiliationName": "MemorialCare Medical Foundation",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "FHIR",
            "address_1": "17360 Brookhurst St",
            "city": "Fountain Valley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "927083720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.