Tracy Peterson, R.P.A.C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

008224 Issued in NY

Practice address

1770 Motor Pkwy
Islandia, NY 11749-5260

Phone

(631) 434-1770

Fax

(631) 434-1254

NPI assigned

Sep 27, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722

Interoperability endpoints

• Direct secure messaging: tracypeterson@nslijmedgr.allscriptsdirect.net

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.

• North Shore - Lij Pediatrics of Suffolk County, P.C.

  • Pediatrics Physician
  • Islandia, NY
  • NPI 1255722161
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538438400000",
    "number": "1669563136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 EXPRESSWAY DR N",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495301",
            "telephone_number": "631-434-1770",
            "fax_number": "631-434-1254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 MOTOR PKWY",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495260",
            "telephone_number": "631-434-1770",
            "fax_number": "631-434-1254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TRACY",
        "name_prefix": "Mrs.",
        "credential": "R.P.A.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2018-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "008224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Rose Parise
• Amanda Kathleen Parks, AUD
• Sonia Jagdev Patel, PHARM.D
• PCL Hearing Services/Islip
• Andrew Douglas Pearlman, MD
• Michael Carmine Piampiano, PHARM D. CIP
• Sarah Piracha
• Jenna Polan
• Mikayla Policastro
• Melvin Portnoy

• Physician Assistant in Islandia, NY
• Providers in Islandia, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.