Individual provider Active NPI

Tracey Hudson

  • Occupational Therapist
  • Bay Shore, NY
National Provider Identifier
1497948921
Registry record updated Feb 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
023024-1 Issued in NY
Practice address
10 East Garfield Street
Apt 2a
Bay Shore, NY 11706
Phone
(631) 415-4017
NPI assigned
Aug 17, 2007
Last updated
Feb 6, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 6, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 023024 NY
Developmentally Disabled Services Day Training Agency 251C00000X 006119-1 NY
Occupational Therapist 225X00000X 023024-1 NY Primary

Addresses

Primary practice location

10 East Garfield Street
Apt 2a
Bay Shore, NY 11706

Mailing address

122 S 30TH St
Wyandanch, NY 11798-2711
Phone (631) 491-5988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181203002067 NY Practitioner - Occupational Therapist in Private Practice 8325382369 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progressive Rehab Management CorporationGroup PAC ID 8527496934, 3 clinicians
Epic Medical Services PCGroup PAC ID 8628365582, 27 clinicians

Practice addresses (Care Compare)

15 Pitchpine PL
Medford, NY 11763-4208
Phone (347) 922-4222

1500 Hempstead Tpke
East Meadow, NY 11554-1551
Phone (516) 739-7733

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
023024-1NYMDOccupational Therapist
006119-1NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Progressive Rehab Management Corporation CurrentSince May 1, 2021 Accepting new patients
TH Rehab Occupational Therapy Services, P.C. CurrentSince Oct 31, 2023 Accepting new patients
Epic Medical Services PC CurrentSince Oct 23, 2018 Accepting new patients
Priority One Therapy PT OT SLP PLLC CurrentSince Oct 25, 2024 Accepting new patients
Global SLP OT PT & Psychological Services, PLLC Occupational Therapist CurrentSince Dec 1, 2021 Accepting new patients
Precision PT, OT & SLP Services, PLLC Occupational Therapist CurrentSince Nov 1, 2018 Accepting new patients

Locations

685 River Ave
Lakewood, NJ 08701
Phone (732) 364-3772

146 S Country Rd
Ste 4
Bellport, NY 11713
Phone (631) 803-0738

1500 Hempstead Tpke
East Meadow, NY 11554
Phone 51673977331420

1979 Marcus Ave
Ste 204
New Hyde Park, NY 11042
Phone (516) 327-4681

99 W Hawthorne Ave
Ste 210
Valley Stream, NY 11580
Phone (718) 305-1190

78 Stratton St S
Yonkers, NY 10701
Phone (732) 364-3772

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1187308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549411200000",
    "number": "1497948921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 S 30TH ST",
            "city": "WYANDANCH",
            "state": "NY",
            "postal_code": "117982711",
            "telephone_number": "631-491-5988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 EAST GARFIELD STREET",
            "address_2": "APT 2A",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "11706",
            "telephone_number": "631-415-4017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "TRACEY",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-17",
        "last_updated": "2019-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "023024",
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NY",
            "license": "006119-1",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "023024-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Shore, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.