Active NPI
Robert E. Tracy, D.D.S., P.S.
- General Practice Dentistry
- Seattle, WA
National Provider Identifier
1447304019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DE00004990
- Practice address
- 11066 5TH Ave NE
Suite 200
Seattle, WA 98125-6156 - Phone
- (206) 362-3833
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE00004990 | WA | Primary |
Addresses
Primary practice location
11066 5TH Ave NE
Suite 200
Seattle, WA 98125-6156
Mailing address
11066 5TH Ave NE
Suite 200
Seattle, WA 98125-6156
Phone (206) 362-3833
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 970226 | Other | WA | UNITED CONCORDIA ID |
| 91-1188334 | Other | WA | TAX ID # |
| 4990 | Other | WA | LICENSE |
| 5002043 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr. Robert E. Tracy D.D.S., P.S. | Past | Accepting new patients |
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.
-
- Dental Clinic/Center
- Seattle, WA
- NPI 1962647578
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228867200000",
"number": "1447304019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11066 5TH AVE NE",
"address_2": "SUITE 200",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981256156",
"telephone_number": "206-362-3833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11066 5TH AVE NE",
"address_2": "SUITE 200",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981256156",
"telephone_number": "206-362-3833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACY",
"first_name": "ROBERT",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "D.D.S., P.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2008-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE00004990",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA ID",
"identifier": "970226",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID #",
"identifier": "91-1188334",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "4990",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5002043",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; 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.