Active NPI
Tracy Lynn McDonell
- Community Health Worker
- Fresno, CA
National Provider Identifier
1447709993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 153 N U St
Fresno, CA 93701-2438 - Phone
- (559) 445-9094
- NPI assigned
- Sep 26, 2016
- Last updated
- May 22, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | NU | Primary | |
| Case Manager/Care Coordinator | 171M00000X | NU |
Addresses
Primary practice location
153 N U St
Fresno, CA 93701-2438
Mailing address
153 N U St Ste 108
Fresno, CA 93701-2438
Phone (550) 445-9094
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100039AN | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crestwood Behavioral Health, Inc. | Past | Accepting new patients | |
| Fresno County Crestwood Fresno Bridge | Past | Accepting new patients |
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.
-
dba Bridge Program - Fresno
- Mental Illness Community Based Residential Treatment Facility
- Fresno, CA
- NPI 1093892663
-
- Psychiatric Residential Treatment Facility
- Fresno, CA
- NPI 1558499749
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684713600000",
"number": "1447709993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "153 N U ST STE 108",
"city": "FRESNO",
"state": "CA",
"postal_code": "937012438",
"telephone_number": "550-445-9094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "153 N U ST",
"city": "FRESNO",
"state": "CA",
"postal_code": "937012438",
"telephone_number": "559-445-9094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONELL",
"first_name": "TRACY",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-26",
"last_updated": "2023-05-22",
"certification_date": "2023-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100039AN",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.