NPIMap

Individual provider Active NPI

Tracy A Lillie, M.D.

  • Family Medicine Physician
  • Huntingdon, PA
National Provider Identifier
1689650848
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD066530L Issued in PA
Practice address
790 Bryan St
Huntingdon, PA 16652-2410
Phone
(814) 643-8299
Fax
(814) 643-8300
NPI assigned
Dec 20, 2005
Last updated
Jun 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD066530L PA Primary

Addresses

Primary practice location

790 Bryan St
Huntingdon, PA 16652-2410

Mailing address

4133 Medical Center Dr
Broad Top, PA 16621-9001
Phone (814) 635-2916

Other identifiers 1

IdentifierTypeStateIssuer
0017391890006MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20050322000419 PA Practitioner - Family Practice 5597710640 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Columbia School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

846 Medical Ctr Dr
Alexandria, PA 16611-2936
Phone (814) 667-7400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD066530LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Broad Top Area Medical Center Inc CurrentSince Feb 26, 2022 Accepting new patients
J C Blair Medical Services Inc Family Medicine CurrentSince Mar 1, 2016 Accepting new patients
Broad Top Area Medical Center Inc PastSince Aug 1, 2021 Accepting new patients
Windber Hospital, Inc. Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Broad Top Area Medical Center, Inc PastSince May 25, 2021 Accepting new patients

Locations

846 Medical Center Dr
Alexandria, PA 16611
Phone (814) 667-7400

4133 Medical Center Dr
Broad Top, PA 16621
Phone (814) 506-8463

1225 Warm Springs Ave
Huntingdon, PA 16652
Phone (814) 643-8206

7651 Lake Raystown Shopping Ctr
Huntingdon, PA 16652
Phone (814) 643-8485

790 Bryan St
Huntingdon, PA 16652
Phone (814) 643-8299

790 Bryan St
#1
Huntingdon, PA 16652

790 Bryan St
#2
Huntingdon, PA 16652
Phone (814) 506-8114

Interoperability endpoints

  • Direct secure messaging: t.lillie@broadtopmedical.medentdirect.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Broad Top Area Medical Center IncBroad Top, PA, CCN 391853 Federally qualified health center Corporate Officer Jan 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 7

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 52

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1689650848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4133 MEDICAL CENTER DR",
            "city": "BROAD TOP",
            "state": "PA",
            "postal_code": "166219001",
            "telephone_number": "814-635-2916",
            "fax_number": "814-635-2918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 BRYAN ST",
            "city": "HUNTINGDON",
            "state": "PA",
            "postal_code": "166522410",
            "telephone_number": "814-643-8299",
            "fax_number": "814-643-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLIE",
        "first_name": "TRACY",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-20",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD066530L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017391890006",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntingdon, PA

Sources for this page

Verify at the official NPI Registry.