Active NPI
Tracye Pons, LSW
- Social Worker
- Urbana, IL
National Provider Identifier
1649653445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150015112
- Practice address
- 2208 E Country Squire Dr
Urbana, IL 61802-5604 - Phone
- (239) 789-5264
- NPI assigned
- Jun 30, 2015
- Last updated
- Jun 30, 2015
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 150015112 | IL | Primary |
Addresses
Primary practice location
2208 E Country Squire Dr
Urbana, IL 61802-5604
Mailing address
2208 E Country Squire Dr
Urbana, IL 61802-5604
Phone (239) 789-5264
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150015112 | IL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435622400000",
"number": "1649653445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2208 E COUNTRY SQUIRE DR",
"city": "URBANA",
"state": "IL",
"postal_code": "618025604",
"telephone_number": "239-789-5264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2208 E COUNTRY SQUIRE DR",
"city": "URBANA",
"state": "IL",
"postal_code": "618025604",
"telephone_number": "239-789-5264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PONS",
"first_name": "TRACYE",
"credential": "LSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-06-30",
"last_updated": "2015-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150015112",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Urbana, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.