NPIMap

Individual provider Active NPI

Deirdre Tara Tracey

  • Family Nurse Practitioner
  • Grosse Pointe, MI
National Provider Identifier
1659918258
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704303811 Issued in MI
Practice address
17120 Kercheval Ave
Grosse Pointe, MI 48230-1661
Phone
(313) 886-3300
NPI assigned
Dec 3, 2019
Last updated
Mar 24, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704303811 MI Primary

Addresses

Primary practice location

17120 Kercheval Ave
Grosse Pointe, MI 48230-1661

Mailing address

17120 Kercheval Ave
Grosse Pointe, MI 48230-1661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20200504000170 MI Practitioner - Nurse Practitioner 9133550353 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Total Extended Care Services PCGroup PAC ID 9133029127, 29 clinicians
Transitional Care Services LLCGroup PAC ID 6709165954, 45 clinicians

Practice addresses (Care Compare)

18312 Middlebelt Rd
Livonia, MI 48152-5007
Phone (248) 426-9944

4568 W Walton Blvd
Suite D
Waterford, MI 48329-4900
Phone (855) 466-3631

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704303811MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Paragon Clinical LLC Family CurrentSince Apr 14, 2020 Accepting new patients
Transitional Care Services, LLC CurrentSince Jul 21, 2025 Accepting new patients
Total Extended Care Services PC CurrentSince Jun 1, 2025 Accepting new patients
Minuteclinic Diagnostic of Michigan PC Family CurrentSince Apr 11, 2025 Accepting new patients
North Woodward Internal Medicine Associates, P.C. PastSince Dec 1, 2019 Accepting new patients
Paragon Clinical Midwest, LLC Past Accepting new patients
Wellbridge of Clarkston, LLC Past Accepting new patients
Osf Multi-Specialty Group Past Accepting new patients

Locations

745 McClintock Dr
Ste 360
Burr Ridge, IL 60527
Phone (630) 506-1245

1385 E Empire Ave
Benton Harbor, MI 49022
Phone (269) 925-0033

725 Fuller Ave
Big Rapids, MI 49307
Phone (231) 796-2631

17120 Kercheval Ave
Grosse Pointe, MI 48230
Phone (313) 886-3300

18312 Middlebelt Rd
Livonia, MI 48152
Phone (248) 426-9944

39350 9 Mile Rd
Northville Township, MI 48167
Phone (248) 735-6081

25375 Kelly Rd
Roseville, MI 48066
Phone (586) 733-6022

4568 W Walton Blvd
Ste D
Waterford Township, MI 48329
Phone (855) 466-3631

6950 Farmington Rd
West Bloomfield, MI 48322
Phone (248) 478-5645

Interoperability endpoints

  • Direct secure messaging: deirdre.tracey.1@31855.direct.athenahealth.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1575331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1659918258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17120 KERCHEVAL AVE",
            "city": "GROSSE POINTE",
            "state": "MI",
            "postal_code": "482301661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17120 KERCHEVAL AVE",
            "city": "GROSSE POINTE",
            "state": "MI",
            "postal_code": "482301661",
            "telephone_number": "313-886-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRACEY",
        "first_name": "DEIRDRE",
        "middle_name": "TARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-03",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704303811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grosse Pointe, MI

Sources for this page

Verify at the official NPI Registry.