Individual provider Active NPI

Andrea Tracy, MD

  • Pediatrics Physician
  • Brunswick, ME
National Provider Identifier
1679583447
Registry record updated Aug 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD12917 Issued in ME
Practice address
74 Baribeau Dr
Brunswick, ME 04011-3218
Phone
(207) 798-4050
Fax
(207) 798-4018
NPI assigned
Aug 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD12917 ME Primary

Addresses

Primary practice location

74 Baribeau Dr
Brunswick, ME 04011-3218

Mailing address

PO Box 9746
Portland, ME 04104-5040
Phone (207) 791-3888

Other identifiers 1

IdentifierTypeStateIssuer
285990099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060202000560 ME Practitioner - Pediatric Medicine 1759395395 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD12917MEMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Martin'S Point Health Care, Inc. Pediatrics CurrentSince Jan 1, 2012 Accepting new patients

Locations

68 Graham St
Biddeford, ME 04005
Phone (207) 283-1441

74 Baribeau Dr
Brunswick, ME 04011
Phone (207) 798-4050

174 S Freeport Rd
Freeport, ME 04032
Phone (207) 865-1819

510 Main St
Gorham, ME 04038
Phone (207) 216-2118

6 Farley Rd
Mere Point, ME 04011
Phone (207) 725-8079

331 Veranda St
Portland, ME 04103
Phone (207) 774-5801

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/5857/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344470400000",
    "number": "1679583447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9746",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041045040",
            "telephone_number": "207-791-3888",
            "fax_number": "207-828-7850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 BARIBEAU DR",
            "city": "BRUNSWICK",
            "state": "ME",
            "postal_code": "040113218",
            "telephone_number": "207-798-4050",
            "fax_number": "207-798-4018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRACY",
        "first_name": "ANDREA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2012-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ME",
            "license": "MD12917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "285990099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, ME

Sources for this page

Verify at the official NPI Registry.