NPIMap

Individual provider Active NPI

Tracy Lee Pride, PA

  • Physician Assistant
  • Lansing, MI
National Provider Identifier
1548375934
Registry record updated Sep 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004110 Issued in MI
Practice address
1140 E Michigan Ave Ste 400
Lansing, MI 48912-1806
Phone
(517) 364-9650
Fax
(517) 364-9605
NPI assigned
Aug 19, 2006
Last updated
Sep 20, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601004110 MI Primary

Addresses

Primary practice location

1140 E Michigan Ave Ste 400
Lansing, MI 48912-1806

Mailing address

PO Box 13008
Lansing, MI 48901-3008
Phone (517) 364-9650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051107000122 MI Practitioner - Physician Assistant 4486672664 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1140 E Michigan Ave
Lansing, MI 48912-1806

1215 E Michigan Ave
Lansing, MI 48912-1811

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601004110MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Edward W Sparrow Hospital Association Physician Assistant CurrentSince Apr 1, 2015 Accepting new patients
Edward W Sparrow Hospital Association CurrentSince Apr 1, 2015 Accepting new patients
Edward W Sparrow Hospital Association Current Accepting new patients
Edward W. Sparrow Hospital Association Past Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

800 W Lawrence Ave
Charlotte, MI 48813
Phone (517) 541-5800

520 E Washington St
Ionia, MI 48846
Phone (616) 527-4200

1140 E Michigan Ave
Ste 40
Lansing, MI 48912
Phone (517) 483-7550

1140 E Michigan Ave
Ste 400
Lansing, MI 48912
Phone (517) 483-7550

1200 E Michigan Ave
Ste 500
Lansing, MI 48912
Phone (517) 364-5123

3301 E Michigan Ave
Ste A
Lansing, MI 48912
Phone (517) 364-8600

405 W Greenlawn Ave
Ste 400
Lansing, MI 48910
Phone (517) 483-7541

Interoperability endpoints

  • Direct secure messaging: tpride15614@sparrowdirecthie.org

Organizations & group practices 5

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568937600000",
    "number": "1548375934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13008",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489013008",
            "telephone_number": "517-364-9650",
            "fax_number": "517-364-9605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 E MICHIGAN AVE STE 400",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121806",
            "telephone_number": "517-364-9650",
            "fax_number": "517-364-9605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIDE",
        "first_name": "TRACY",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-19",
        "last_updated": "2019-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

Verify at the official NPI Registry.