Tracie Malsom, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

642 Issued in ND

Practice address

1695 43Rd St S
Fargo, ND 58103-3317

Phone

(701) 235-3937

Fax

(701) 356-3937

NPI assigned

May 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in ND

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lance K Bergstrom MD PCGroup PAC ID 3577542216, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

64.46 of 100Reported as individual

Quality

28.92

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lance K Bergstrom MD, PC

  • Specialist
  • Fargo, ND
  • NPI 1801819826

  Optometrist

  Medicare reassignment Care Compare group NPD
• Melissa J McCulley O D P C

  • Optometrist
  • West Fargo, ND
  • NPI 1497871214
  Medicare reassignment
• Steven B Thom, MD PC

  • Ophthalmology Physician
  • Fargo, ND
  • NPI 1821233073
  NPD (past)
• City Optical Co., Inc.

  • Optometrist
  • Merrillville, IN
  • NPI 1356233068
  NPD (past)
• City Optical Co., Inc.

  • Optometrist
  • Lebanon, IN
  • NPI 1568791697
  NPD (past)
• Dr Tavel of Evansville, LLC

  • Optometrist
  • Evansville, IN
  • NPI 1205825700
  NPD (past)
• Neurohealth LTD

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1598967309
  NPD (past)

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380240000000",
    "number": "1720038441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 43RD ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033317",
            "telephone_number": "701-235-3937",
            "fax_number": "701-356-3937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 43RD ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033317",
            "telephone_number": "701-235-3937",
            "fax_number": "701-356-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALSOM",
        "first_name": "TRACIE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2013-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003360",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ND",
            "license": "642",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "3046",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Keith Maliske, CRNA
• Tracie Marie Mallberg- Sylvester, M.D.
• Nora Mallow
• Hani Malone, M.D.
• Inna Malostovker, MD
• Katarina Malterud
• Jennifer Jean Malusky, LPN
• Sherry Maly, RN
• Mama Homecare LLC
• Rushana Manatova, MD

• Optometrist in Fargo, ND
• Providers in Fargo, ND by specialty
• Optometrist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; 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.