Tracy Ann Haertling, D.O.

Primary specialty

Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X

License

02004056A Issued in IN

Practice address

615 N Michigan St
6 East
South Bend, IN 46601-1033

Phone

(574) 647-6892

Fax

(574) 647-6895

NPI assigned

Jul 31, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Beacon Medical Group, Inc.

  • Orthopaedic Surgery Physician
  • South Bend, IN
  • NPI 1831149525
  NPD (past)

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

{
    "created_epoch": "1185840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1458086400000",
    "number": "1821288333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST",
            "address_2": "6 EAST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-6892",
            "fax_number": "574-647-6895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAERTLING",
        "first_name": "TRACY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-31",
        "last_updated": "2016-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "IL",
            "license": "036123303",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "IN",
            "license": "02004056A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MEMORIAL CHILDRENS HOSPITAL",
            "identifier": "000000781399",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201085280",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aidan Irene Gwartney
• Gwendolyn Dehorn LCSW LLC
• Benjamin Haberly
• Nancy Jean Hadley, LCSW
• Almira Hadzimesic, NP
• Alison Haffner, NP
• Charles Frederick Hagenow, M.D.
• Christopher Haggans
• Holly L Hake-Harris, MD
• Sara Ruth Hake, FNP

• Pediatric Hematology & Oncology Physician in South Bend, IN
• Providers in South Bend, IN by specialty
• Pediatric Hematology & Oncology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.