Active NPI
Donald Tracy
- Pediatric Radiology Physician
- Boston, MA
National Provider Identifier
1730110099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Radiology Physician
- License
- 75774
- Practice address
- 300 Longwood Ave
Boston, MA 02115-5724 - Phone
- (617) 355-8382
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pediatric Radiology Physician | 2085P0229X | 75774 | MA | Primary |
Addresses
Primary practice location
300 Longwood Ave
Boston, MA 02115-5724
Mailing address
14 Ordway Rd
Wellesley, MA 02481-6709
Phone (614) 355-6936
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C05267 | Other | MA | BCBS |
| 106984 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75774 | MA | MD | Pediatric Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children'S Hospital Radiology Foundation, Inc. | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Boston, MA
- NPI 1487681912
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1730110099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 ORDWAY RD",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024816709",
"telephone_number": "614-355-6936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 LONGWOOD AVE",
"city": "BOSTON",
"state": "MA",
"postal_code": "021155724",
"telephone_number": "617-355-8382"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRACY",
"first_name": "DONALD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2085P0229X",
"taxonomy_group": "",
"desc": "Radiology, Pediatric Radiology",
"state": "MA",
"license": "75774",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "C05267",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "106984",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.