Individual provider Active NPI

Traci I Emerson, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Evansville, IN
National Provider Identifier
1578076337
Registry record updated Jan 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
71007727A Issued in IN
Practice address
3700 Washington Ave
Evansville, IN 47714-0541
Phone
(812) 485-4000
NPI assigned
Nov 14, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 71007727A IN
Acute Care Nurse Practitioner 363LA2100X 71007727A IN Primary
Adult Health Nurse Practitioner 363LA2200X 71007727A IN

Addresses

Primary practice location

3700 Washington Ave
Evansville, IN 47714-0541

Mailing address

10330 N Meridian St # 300
Indianapolis, IN 46290-1024

Other practice location 1

3700 Washington Ave
Evansville, IN 47714-0541
Phone (812) 485-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20180214000457 IN Practitioner - Nurse Practitioner 0749540672 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
71007727AINMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Mary'S Medical Group, LLC Acute Care CurrentSince Jan 13, 2018 Accepting new patients
St Mary'S Medical Group, LLC CurrentSince Jan 13, 2018 Accepting new patients

Locations

1116 Millis Ave
Boonville, IN 47601
Phone (812) 897-4800

801 Saint Marys Dr
Ste 505E
Evansville, IN 47714
Phone (812) 491-3236

3700 Washington Ave
Evansville, IN 47714
Phone (812) 232-0021

3801 Bellemeade Ave
Ste 110
Evansville, IN 47714
Phone (812) 471-1200

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": "1510617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517270400000",
    "number": "1578076337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10330 N MERIDIAN ST # 300",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462901024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 WASHINGTON AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140541",
            "telephone_number": "812-485-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3700 Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477140541",
            "country_code": "US",
            "telephone_number": "812-485-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EMERSON",
        "first_name": "TRACI",
        "middle_name": "I",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-14",
        "last_updated": "2018-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71007727A",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "IN",
            "license": "71007727A",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "IN",
            "license": "71007727A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.