NPIMap

Individual provider Active NPI

Tracy L Hall, D.O.

  • Sports Medicine (Family Medicine) Physician
  • Greenville, IL
National Provider Identifier
1659366102
Registry record updated Dec 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
036083073 Issued in IL
Practice address
201 Health Care Dr
Greenville, IL 62246-1155
Phone
(618) 664-1380
Fax
(618) 664-4239
NPI assigned
Sep 12, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X 036083073 IL Primary

Addresses

Primary practice location

201 Health Care Dr
Greenville, IL 62246-1155

Mailing address

200 Health Care Dr
Greenville, IL 62246-1154
Phone (618) 664-1380

Other identifiers 1

IdentifierTypeStateIssuer
036083073MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address thall100793@ewd.direct.hshs.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20100723000117 IL Practitioner - Family Practice 4385606045 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
HSHS Holy Family Hospital Inc 25 clinicians

Practice addresses (Care Compare)

101 Health Care Dr
Greenville, IL 62246-1159
Phone (618) 664-1380

Hospital & facility affiliations

  • Bond County Health Department Home health agency, Greenville, IL, CCN 147023
  • HSHS Holy Family Hospital Inc Hospital, Greenville, IL, CCN 140137
  • Fayette County Hospital Hospital, Vandalia, IL, CCN 141346
  • St Joseph'S Hospital Hospital, Highland, IL, CCN 141336
  • St Josephs Hospital Hospital, Breese, IL, CCN 140145
  • Hillsboro Area Hospital Hospital, Hillsboro, IL, CCN 141332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
036083073ILMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
HSHS Holy Family Hospital Inc CurrentSince Mar 31, 2012 Accepting new patients
HSHS Medical Group Inc Current Accepting new patients
HSHS Medical Group Inc CurrentSince Sep 15, 2022 Accepting new patients
HSHS Medical Group Inc CurrentSince Sep 15, 2022 Accepting new patients
HSHS Holy Family Hospital Inc Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1900 E Lake Shore Dr
Ste 330
Decatur, IL 62521
Phone (217) 423-2889

200 Health Care Dr
Greenville, IL 62246
Phone (618) 664-0808

201 Health Care Dr
Greenville, IL 62246
Phone (618) 664-1380

200 Health Care Dr
#1501
Greenville, IL 62246
Phone (616) 664-1230

1512 N Green Mount Rd
O Fallon, IL 62269
Phone (618) 624-0100

3051 Hollis Dr
Fl 2
Springfield, IL 62704
Phone (217) 321-9321

Interoperability endpoints

  • Direct secure messaging: thall100793@ewd.direct.hshs.org

Organizations & group practices 9

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 8

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": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1659366102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HEALTH CARE DR",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622461154",
            "telephone_number": "618-664-1380",
            "fax_number": "618-664-4239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 HEALTH CARE DR",
            "city": "GREENVILLE",
            "state": "IL",
            "postal_code": "622461155",
            "telephone_number": "618-664-1380",
            "fax_number": "618-664-4239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "TRACY",
        "middle_name": "L",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-12",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IL",
            "license": "036083073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036083073",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "thall100793@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "201 Health Care Dr",
            "city": "Greenville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622461155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Greenville, IL

Sources for this page

Verify at the official NPI Registry.