Tracie Baretela, PA
Individual provider Active NPI Physician Assistant · Dilkon, AZ
NPI 1699734335 · NPPES record last updated Nov 24, 2024
Key facts
- NPI
- 1699734335
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 9887 (AZ)
- Practice address
- HC 63 Box 9000
Dilkon, AZ 86047-9477 - Phone
- (928) 657-1000
- Fax
- (928) 289-6229
- NPI assigned
- Mar 21, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 30
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4100 International PLZ
Fort Worth, TX 76109-4800
PO Box
Los Angeles, CA 90074
Hospital & facility affiliations
- Exceptional Community Hospital Bullhead City
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (5 enrollments) in UT, WA, AZ, TX, NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050519000507 | UT | Practitioner - Physician Assistant | 7315988359 | Reassigns benefits to 2 organizations |
| I20060504000381 | WA | Practitioner - Physician Assistant | 7315988359 | Reassigns benefits to 5 organizations |
| I20241120004456 | AZ | Practitioner - Physician Assistant | 7315988359 | Reassigns benefits to 2 organizations |
| I20250423000881 | TX | Practitioner - Physician Assistant | 7315988359 | Reassigns benefits to 3 organizations |
| I20260415003285 | NM | Practitioner - Physician Assistant | 7315988359 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15384 | CA | MD | Speech-Language Pathologist |
| 9887 | AZ | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gila River Health Care | Current |
Accepting new patients | |
| DHHS PHS Naihs Chinle Comprehensive | Current |
Accepting new patients | |
| Tri-State Memorial Hospital | Current |
Accepting new patients | |
| Cep America LLC | Emergency Medicine | Current |
Accepting new patients |
| Winslow Indian Health Care Center, Inc | Current |
Accepting new patients | |
| Winslow Indian Health Care Group | Current |
Accepting new patients | |
| Grant County Public Hospital District 1 | Current |
Accepting new patients | |
| Grant County Public Hospital District 1 | Current |
Accepting new patients | |
| University of Utah Adult Services | Current |
Accepting new patients | |
| Gila River Health Care Corporation | Current |
Accepting new patients | |
| DHHS PHS Naihs Chinle Comprehensive Health Care Facility | Current |
Accepting new patients | |
| Tri-State Memorial Hospital | Current |
Accepting new patients | |
| Cep America LLC | Emergency Medicine | Current |
Accepting new patients |
| Gila River Health Care Corporation | Current | Accepting new patients | |
| Tacoma Emergency Care Physicians, PLLC | Emergency Medicine | Current |
Accepting new patients |
| University of Utah Adult Services | Current |
Accepting new patients | |
| Tri-State Memorial Hospital | Current |
Accepting new patients | |
| Exceptional Physicians Group Bullhead City Hospital PLLC | Current |
Accepting new patients | |
| Exceptional Health Care Bullhead City LLC | Past |
Accepting new patients | |
| Tri-State Memorial Hospital | Past | Accepting new patients | |
| Lutheran Hospital Association of the San Luis Valley | Past | Accepting new patients |
Locations
2365 Highway 95
Bullhead City, AZ 86442
Phone (928) 224-2443
17487 S Healthcare Dr
#H
Laveen, AZ 85339
Phone (520) 550-6000
500 Indiana Ave
Winslow, AZ 86047
1501 N Williamson Ave
Winslow, AZ 86047
Phone (928) 289-4691
1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423
50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292
1221 Highland Ave
Clarkston, WA 99403
Phone (509) 751-0312
21601 76th Ave W
Edmonds, WA 98026
Phone (425) 640-4000
17700 SE 272nd St
Kent, WA 98042
Phone (253) 372-6500
660 S Coolidge St
Moses Lake, WA 98837
2000 S Clover Dr
Moses Lake, WA 98837
Phone (509) 765-5606
801 E Wheeler Rd
Moses Lake, WA 98837
Phone (509) 765-5606
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | PA10005007 | WA | |
| Physician Assistant | 363A00000X | PA10005007 | WA | |
| Physician Assistant | 363A00000X | 9887 | AZ | Yes |
Addresses
Primary practice location
HC 63 Box 9000
Dilkon, AZ 86047-9477
Mailing address
5349 W Canary Grass Way
South Jordan, UT 84009-1399
Phone (360) 689-6397
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8451411 | Medicaid | WA |
Other providers in Dilkon, AZ
- Frank Crowder
- Janell K Dickson
- Dilkon Medical Center
- Dilkon Medical Center Pharmacy
- Hozho Wellness PLLC
All providers in Dilkon, AZ · Physician Assistant in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.