NPIMap

Individual provider Active NPI

Tracey Lynn Judy, APRN-CNP

  • Nurse Practitioner
  • Charleston, WV
National Provider Identifier
1770171225
Registry record updated Jan 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
108128 Issued in WV
Practice address
3100 Maccorkle Ave SE Ste 411
Charleston, WV 25304-1230
Phone
(304) 343-4400
NPI assigned
Jan 8, 2021
Last updated
Jan 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2021

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 108128 WV Primary

Addresses

Primary practice location

3100 Maccorkle Ave SE Ste 411
Charleston, WV 25304-1230

Mailing address

1401 Lakewood Dr
Charleston, WV 25312-5930
Phone (304) 651-5734

Other names 1

  • Tracey Gregory Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210305000530 WV Practitioner - Nurse Practitioner 4385050962 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-7823

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. CurrentSince Dec 28, 2021 Accepting new patients
Neurology & Headache Clinic PLLC CurrentSince Feb 1, 2021 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Dec 28, 2021 Accepting new patients

Locations

3100 Maccorkle Ave SE
Ste 411
Charleston, WV 25304
Phone (304) 343-4400

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CEFFAA

Organizations & group practices 3

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1610064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610150400000",
    "number": "1770171225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 LAKEWOOD DR",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253125930",
            "telephone_number": "304-651-5734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE SE STE 411",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041230",
            "telephone_number": "304-343-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUDY",
        "first_name": "TRACEY",
        "middle_name": "LYNN",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-08",
        "last_updated": "2021-01-09",
        "certification_date": "2021-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WV",
            "license": "108128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "GREGORY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.