Tracy Alan Scott, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DE60372812 Issued in WA

Practice address

12400 Kallgren Rd NE
Bainbridge Island, WA 98110

Phone

(760) 532-2127

NPI assigned

Feb 24, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 10, 2020 through Oct 10, 2026

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527120000000",
    "number": "1821064452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12400 KALLGREN RD NE",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981103328",
            "telephone_number": "760-532-2127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12400 KALLGREN RD NE",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "98110",
            "telephone_number": "760-532-2127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "TRACY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2018-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "WA",
            "license": "DE60372812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynn Kathryn Schorn, P.T.
• Mark David Schorn, P.T.
• Monica Lynn Schutt, DPT
• Steven G. Schwager, DDS
• Colleen S. Scott, PTA
• Christina L Segan, L.M.P.
• McKinley T Self, DMD
• Abigail Selig
• Serena Matthews Occupational Therapy Services LLC
• Carol B Shakow, MSW LICSW

• Periodontics in Bainbridge Island, WA
• Providers in Bainbridge Island, WA by specialty
• Periodontics in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.