Tracie Medrano- Smith, D.O

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

5315069986 Issued in MI

Practice address

4174 56TH St SW
Wyoming, MI 49418

Phone

(616) 458-3677

NPI assigned

Jun 15, 2015

Last updated

Aug 13, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Abc Pediatrics, PC

  • Pediatrics Physician
  • Walker, MI
  • NPI 1295836096
  NPD (past)
• Spectrum Health Hospitals

  dba Corewell Health Grand Rapids Hospital

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  NPD (past)

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

{
    "created_epoch": "1434326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565654400000",
    "number": "1710368782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4288 3 MILE RD NW",
            "city": "WALKER",
            "state": "MI",
            "postal_code": "495347596",
            "telephone_number": "616-458-3677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4174 56TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "49418",
            "telephone_number": "616-458-3677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "330 Barclay Ave NE Ste 300",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495032527",
            "country_code": "US",
            "telephone_number": "616-391-8810",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4288 3 Mile Rd NW",
            "address_purpose": "LOCATION",
            "city": "Walker",
            "state": "MI",
            "postal_code": "495347596",
            "country_code": "US",
            "telephone_number": "616-458-3677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDRANO- SMITH",
        "first_name": "TRACIE",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-15",
        "last_updated": "2019-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101021683",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5315069986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brooke McNamara
• Michael W McNamara, M.D.
• Alyse Marie Meadows
• Shannon J Mechan, OTR/L
• Medexpress Urgent Care, PC - Michigan (MedExpress Urgent Care - Wyoming, 28th St SW)
• Betsy M Meerman, PA
• Amber Meeuwsen, REGISTERED NURSE
• Magdelynn Mege
• Meijer Inc (Meijer Pharmacy #036)
• Robert J Meleca, M.D., FACS

• Pediatrics Physician in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; 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.

Verify at the official NPI Registry.