Individual provider Active NPI

Tracy L Houle, APRN

  • Nurse Practitioner
  • Plymouth, CT
National Provider Identifier
1699726869
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2671 Issued in CT
Practice address
204 Keegan Rd
Plymouth, CT 06782-2608
Phone
(860) 340-8280
Fax
(860) 283-9851
NPI assigned
May 13, 2006
Last updated
Feb 2, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Clinical Nurse Specialist 364SM0705X 002671 CT
Nurse Practitioner 363L00000X 2671 CT Primary

Addresses

Primary practice location

204 Keegan Rd
Plymouth, CT 06782-2608

Mailing address

12 Rolling Ridge CT
Prospect, CT 06712-1737
Phone (203) 758-0836

Other identifiers 1

IdentifierTypeStateIssuer
004247963MedicaidCT

Other names 1

  • Tracy L. Holt Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20120419000613 CT Practitioner - Nurse Practitioner 6709849599 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gaylord Hospital, Inc.Group PAC ID 1153224191, 39 clinicians

Practice addresses (Care Compare)

28 Durham Rd
Suite 1
Madison, CT 06443-2699
Phone (203) 284-2800

50 Gaylord Farm Rd
Wallingford, CT 06492-2828
Phone (203) 284-2800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.25 of 100Reported as group
Quality
63.07
Improvement activities
40
Cost
77.51

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
002671CTMDDental Hygienist
2671CTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gaylord Hospital, Inc. CurrentSince May 1, 2012 Accepting new patients
Trinity Health of New England Provider Network Organization Inc Past Accepting new patients
Connecticut Clinical Nursing Associates, LLC Nurse Practitioner PastSince Feb 12, 2022 Accepting new patients

Locations

50 Gaylord Farm Rd
Wallingford, CT 06492
Phone (203) 679-3553

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328140800000",
    "number": "1699726869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 ROLLING RIDGE CT",
            "city": "PROSPECT",
            "state": "CT",
            "postal_code": "067121737",
            "telephone_number": "203-758-0836",
            "fax_number": "203-758-0836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 KEEGAN RD",
            "city": "PLYMOUTH",
            "state": "CT",
            "postal_code": "067822608",
            "telephone_number": "860-340-8280",
            "fax_number": "860-283-9851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOULE",
        "first_name": "TRACY",
        "middle_name": "L",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-13",
        "last_updated": "2012-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SM0705X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Medical-Surgical",
            "state": "CT",
            "license": "002671",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "2671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004247963",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "HOLT",
            "middle_name": "L.",
            "credential": "APRN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Plymouth, CT

Sources for this page

Verify at the official NPI Registry.