Active NPI
Tracie W Gong, M.D.
- Pediatrics Physician
- Madera, CA
National Provider Identifier
1598887515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A95349
- Practice address
- 9300 Valley Childrens PL
Madera, CA 93638-8761 - Phone
- (559) 353-5174
- Fax
- (559) 353-5318
- NPI assigned
- Apr 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A95349 | CA | Primary |
Addresses
Primary practice location
9300 Valley Childrens PL
Madera, CA 93638-8761
Mailing address
9300 Valley Childrens PL
Madera, CA 93638-8761
Phone (559) 353-5174
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A95349 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Valley Children'S Specialty Medical Group, Inc. | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Madera, CA
- NPI 1013968296
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1598887515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9300 VALLEY CHILDRENS PL",
"city": "MADERA",
"state": "CA",
"postal_code": "936388761",
"telephone_number": "559-353-5174",
"fax_number": "559-353-5318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9300 VALLEY CHILDRENS PL",
"city": "MADERA",
"state": "CA",
"postal_code": "936388761",
"telephone_number": "559-353-5174",
"fax_number": "559-353-5318"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONG",
"first_name": "TRACIE",
"middle_name": "W",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A95349",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.