Tracy My Ngo

Primary specialty

DentistTaxonomy code 122300000X

License

DDS102710 Issued in CA

Practice address

1113 Highway 49
San Andreas, CA 95249

Phone

(209) 755-1460

Fax

(209) 754-6278

NPI assigned

Jul 25, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Cares Community Health

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
  • NPI 1447297379
  Medicare reassignment NPD
• Cares Community Health

  • Federally Qualified Health Center (FQHC)
  • Carmichael, CA
  • NPI 1255180873
  NPD

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665446400000",
    "number": "1578040135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 939",
            "city": "ANGELS CAMP",
            "state": "CA",
            "postal_code": "952220939",
            "telephone_number": "209-754-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 HIGHWAY 49",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "95249",
            "telephone_number": "209-755-1460",
            "fax_number": "209-754-6278"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "777 12th St Ste 250",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958141929",
            "country_code": "US",
            "telephone_number": "916-469-4690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NGO",
        "first_name": "TRACY",
        "middle_name": "MY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-25",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "DDS102710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mountain Oak Health Centers
• Robert Kenneth Mulert, M.D.
• Zachery Richard Murton, MFT INTERN
• Debra Mutopo, FNP
• Melody W Nelson, MT-BC
• Todd Israel Nosanow
• Carla R O'Dell
• Christina O'Flinn, RN
• Oakendell Corporation
• Oakview Health Center

• Dentist in San Andreas, CA
• Providers in San Andreas, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.