Active NPI
Tracey E Chan, NP
- Nurse Practitioner
- Detroit, MI
National Provider Identifier
1710091376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704220570
- Practice address
- 5555 Conner St
Ste 2691
Detroit, MI 48213-3448 - Phone
- (313) 579-1182
- Fax
- (313) 579-5128
- NPI assigned
- Aug 19, 2006
- Last updated
- May 10, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704220570 | MI | Primary |
Addresses
Primary practice location
5555 Conner St
Ste 2691
Detroit, MI 48213-3448
Mailing address
5555 Conner St
Ste 2691
Detroit, MI 48213-3448
Phone (313) 579-1182
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4956148 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704220570 | MI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vpa PC | Current | Accepting new patients | |
| Vpa PC | Current | Accepting new patients | |
| Vpa PC | Current | Accepting new patients |
Locations
500 Kirts Blvd
Ste 200
Troy, MI 48084
Phone (248) 824-6060
Organizations & group practices 4
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304985600000",
"number": "1710091376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5555 CONNER ST",
"address_2": "STE 2691",
"city": "DETROIT",
"state": "MI",
"postal_code": "482133448",
"telephone_number": "313-579-1182",
"fax_number": "313-579-5128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5555 CONNER ST",
"address_2": "STE 2691",
"city": "DETROIT",
"state": "MI",
"postal_code": "482133448",
"telephone_number": "313-579-1182",
"fax_number": "313-579-5128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "TRACEY",
"middle_name": "E",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-19",
"last_updated": "2011-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704220570",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4956148",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.