Individual provider Active NPI

Tracie M Markey, APN

  • Nurse Practitioner
  • Peoria, IL
National Provider Identifier
1760859292
Registry record updated Sep 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
209-013298 Issued in IL
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(309) 624-8818
Fax
(309) 624-8820
NPI assigned
Sep 1, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 209-013298 IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 624-8818

Other names 1

  • Tracie M Watson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150909001571 IL Practitioner - Nurse Practitioner 0840507737 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

530 Neglen Oak Ave
Peoria, IL 61637-0001
Phone (309) 624-8818

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209-013298ILMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients

Locations

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

530neglen Oak Ave
Peoria, IL 61637
Phone (309) 692-5393

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441756800000",
    "number": "1760859292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-8818",
            "fax_number": "309-624-8820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-8818",
            "fax_number": "309-624-8820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARKEY",
        "first_name": "TRACIE",
        "middle_name": "M",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-01",
        "last_updated": "2015-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209-013298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACIE",
            "last_name": "WATSON",
            "middle_name": "M",
            "credential": "APN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.