NPIMap

Individual provider Active NPI

Emily Tracy

  • Physician Assistant
  • Evergreen, CO
National Provider Identifier
1649871518
Registry record updated Mar 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
172 Siesta Cir
Evergreen, CO 80439-4339
Phone
(720) 940-0208
NPI assigned
Nov 5, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2022

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 Primary

Addresses

Primary practice location

172 Siesta Cir
Evergreen, CO 80439-4339

Mailing address

2011 4TH St
La Grande, OR 97850-2511

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20210316001287 OR Practitioner - Physician Assistant 3375959463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Praxis Health PCGroup PAC ID 8325941446, 174 clinicians

Practice addresses (Care Compare)

2011 4TH St
La Grande, OR 97850-2511
Phone (541) 963-4139

354 W Adams Ave
Sisters, OR 97759-2619
Phone (541) 549-9609

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Praxis Health, PC CurrentSince Feb 22, 2021 Accepting new patients
Praxis Health, PC CurrentSince Feb 22, 2021 Accepting new patients

Locations

2011 4th St
La Grande, OR 97850
Phone (541) 963-4139

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.

Hospital & facility affiliations 7

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": "1604534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646265600000",
    "number": "1649871518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 4TH ST",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978502511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 SIESTA CIR",
            "city": "EVERGREEN",
            "state": "CO",
            "postal_code": "804394339",
            "telephone_number": "720-940-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRACY",
        "first_name": "EMILY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-05",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evergreen, CO

Sources for this page

Verify at the official NPI Registry.