Active NPI
Tracy Lynn Delorm, D.D.S.
- General Practice Dentistry
- Lake Stevens, WA
National Provider Identifier
1720171697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9086
- Practice address
- 9421 N Davies Rd
Lake Stevens, WA 98258-9444 - Phone
- (425) 334-4001
- Fax
- (425) 335-4003
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9086 | WA | Primary |
Addresses
Primary practice location
9421 N Davies Rd
Lake Stevens, WA 98258-9444
Mailing address
9421 N Davies Rd
Lake Stevens, WA 98258-9444
Phone (425) 334-4001
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| UNITED CONCORDIA | Other | WA | 1434898 |
| 9086 | Other | WA | LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150707002769 | WA | Order and Referring Only - Oral Surgery | 6002128832 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9086 | WA | MD | General Practice Dentistry |
Organizations & group practices 1
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": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720171697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9421 N DAVIES RD",
"city": "LAKE STEVENS",
"state": "WA",
"postal_code": "982589444",
"telephone_number": "425-334-4001",
"fax_number": "425-335-4003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9421 N DAVIES RD",
"city": "LAKE STEVENS",
"state": "WA",
"postal_code": "982589444",
"telephone_number": "425-334-4001",
"fax_number": "425-335-4003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELORM",
"first_name": "TRACY",
"middle_name": "LYNN",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "9086",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "1434898",
"identifier": "UNITED CONCORDIA",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "9086",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Stevens, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.