Tracy-Jane Luyun Fajota, AGACNP-BC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

95025937 Issued in CA

Practice address

1420 S Central Ave
Glendale, CA 91204-2508

Phone

(818) 502-1900

NPI assigned

Aug 22, 2023

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 CA

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Antaki and Associates Infectious Disease Medical Group IncGroup PAC ID 0941295943, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Glendale Mem Hospital & HLTH Center Hospital, Glendale, CA, CCN 050058

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tracyjane.fajota.p1@direct.lakeside.nextgenshare.com

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.

• Antaki & Associates Infectious Disease Medical Group Inc

  • Infectious Disease Physician
  • Glendale, CA
  • NPI 1124083274
  Medicare reassignment Care Compare group NPD
• Lakeside Medical Organization, a Medical Group Inc.

  • Internal Medicine Physician
  • West Hills, CA
  • NPI 1831426642
  Medicare reassignment NPD

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

• Dignity Community Care

  dba Glendale Memorial Hospital and Health Center

  • General Acute Care Hospital
  • Glendale, CA
  • NPI 1477610640
  Care Compare affiliation

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

{
    "created_epoch": "1692662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1700660560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8510 BALBOA BLVD STE 150",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913255810",
            "telephone_number": "818-636-0501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 S CENTRAL AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042508",
            "telephone_number": "818-502-1900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8510 Balboa Blvd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Northridge",
            "state": "CA",
            "postal_code": "913255810",
            "country_code": "US",
            "telephone_number": "818-654-3400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAJOTA",
        "first_name": "TRACY-JANE",
        "middle_name": "LUYUN",
        "credential": "AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-22",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95025937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Faculty Physicians and Surgeons of Llusm
• Anthony Faggioli IV, AMFT
• Faith & Life Hospice Inc
• Faith in Action Project
• Jorge Fajardo
• Jacob John Fakoory, M.D.
• Family & Friends Home Health Care Inc
• Family Care CLHF, Inc.
• Family Counseling and Guidance Corp
• Family Hospice Services, Inc.

• Acute Care Nurse Practitioner in Glendale, CA
• Providers in Glendale, CA by specialty
• Acute Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.