NPIMap

Individual provider Active NPI

Tracy L Knaak, PA-C

  • Physician Assistant
  • Suffolk, VA
National Provider Identifier
1669418174
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110001540 Issued in VA
Practice address
5818 Harbour View Blvd Ste 240
Suffolk, VA 23435-3315
Phone
(757) 397-2383
Fax
(757) 673-0236
NPI assigned
Jun 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 0110001540 VA
Physician Assistant 363A00000X 0110001540 VA Primary

Addresses

Primary practice location

5818 Harbour View Blvd Ste 240
Suffolk, VA 23435-3315

Mailing address

5818 Harbour View Blvd Ste 240
Suffolk, VA 23435-3315
Phone (757) 397-2383

Other practice location 1

3640 High St
Suite2F
Portsmouth, VA 23707-3213
Phone (757) 397-2383

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20070322000227 VA Practitioner - Physician Assistant 3274637780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

600 Gresham Dr
Norfolk, VA 23507-1904

825 Fairfax Ave
Norfolk, VA 23507-1914

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0110001540VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hampton Roads Otolaryngology Associates PLLC Past Accepting new patients
Maryview Hospital Past Accepting new patients

Organizations & group practices 3

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 6

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1669418174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5818 HARBOUR VIEW BLVD STE 240",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353315",
            "telephone_number": "757-397-2383",
            "fax_number": "757-673-0236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5818 HARBOUR VIEW BLVD STE 240",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353315",
            "telephone_number": "757-397-2383",
            "fax_number": "757-673-0236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3640 High St",
            "address_2": "Suite2F",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "VA",
            "postal_code": "237073213",
            "country_code": "US",
            "telephone_number": "757-397-2383",
            "fax_number": "757-397-2383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KNAAK",
        "first_name": "TRACY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": "0110001540",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110001540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

Verify at the official NPI Registry.