Individual provider Active NPI

Tracy Lynne McTiernan, PNP

  • Pediatric Nurse Practitioner
  • New York, NY
National Provider Identifier
1467671453
Registry record updated Feb 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
F381220 Issued in NY
Practice address
530 1St Ave
Suite 10 W
New York, NY 10016-6402
Phone
(212) 263-7391
Fax
(212) 263-6590
NPI assigned
Apr 25, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X F381220 NY Primary

Addresses

Primary practice location

530 1St Ave
Suite 10 W
New York, NY 10016-6402

Mailing address

292 Hart Ave
Staten Island, NY 10310-3024
Phone (718) 816-8768

Other identifiers 1

IdentifierTypeStateIssuer
02091867MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tmctiernan54536@nyumc.direct-ci.com

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
I20180316000864 NY Practitioner - Nurse Practitioner 0446483481 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
F381220NYMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Mar 15, 2018 Accepting new patients
New York University CurrentSince Mar 15, 2018 Accepting new patients

Locations

550 1st Ave
New York, NY 10016
Phone (212) 263-3293

530 1st Ave
Ste 10
New York, NY 10016
Phone (212) 263-7391

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678

Interoperability endpoints

  • Direct secure messaging: tmctiernan54536@nyumc.direct-ci.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1467671453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "292 HART AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103103024",
            "telephone_number": "718-816-8768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 1ST AVE",
            "address_2": "SUITE 10 W",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100166402",
            "telephone_number": "212-263-7391",
            "fax_number": "212-263-6590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCTIERNAN",
        "first_name": "TRACY",
        "middle_name": "LYNNE",
        "name_prefix": "Mrs.",
        "credential": "PNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-25",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F381220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02091867",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tmctiernan54536@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "530 1st Ave",
            "address_2": "Suite 10 W",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100166402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.