Individual provider Active NPI

Tracy Melinda Arsenault, PA-C

  • Surgical Physician Assistant
  • Irvine, CA
National Provider Identifier
1497056824
Registry record updated Jun 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
085-003952 Issued in IL
Practice address
4980 Barranca Pkwy
Suite 200
Irvine, CA 92604-8645
Phone
(949) 786-5050
NPI assigned
Nov 17, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2014

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 085-003952 IL
Surgical Physician Assistant 363AS0400X 085-003952 IL Primary
Surgical Physician Assistant 363AS0400X 2708-023 WI
Surgical Physician Assistant 363AS0400X 10001255A IN

Addresses

Primary practice location

4980 Barranca Pkwy
Suite 200
Irvine, CA 92604-8645

Mailing address

4980 Barranca Pkwy
Suite 200
Irvine, CA 92604-8645
Phone (949) 786-5050

Other identifiers 1

IdentifierTypeStateIssuer
01618941OtherILBLUECROSS BLUESHIELD

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
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
51224CAMDMarriage & Family Therapist
2708WIMDGeneral Practice Dentistry
085-003952ILMDSurgical Physician Assistant
10001255AINMDSurgical Physician Assistant
2708-023WIMDSurgical Physician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1289952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403740800000",
    "number": "1497056824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4980 BARRANCA PKWY",
            "address_2": "SUITE 200",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926048645",
            "telephone_number": "949-786-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4980 BARRANCA PKWY",
            "address_2": "SUITE 200",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926048645",
            "telephone_number": "949-786-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARSENAULT",
        "first_name": "TRACY",
        "middle_name": "MELINDA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-17",
        "last_updated": "2014-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085-003952",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085-003952",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "2708-023",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10001255A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "01618941",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.