Traci L Ivey, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R4023 Issued in AR

Practice address

2905 S Walton Blvd
Suite 17
Bentonville, AR 72712-6730

Phone

(479) 657-6501

Fax

(479) 657-6375

NPI assigned

May 1, 2006

Last updated

Apr 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: traci.ivey@68079000551428.direct.elationemr.com

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.

• Ivey Family Medicine

  • Primary Care Clinic/Center
  • Bentonville, AR
  • NPI 1932539624
  NPD (past) Authorized official
• Circle of Life

  dba Circle of Life Hospice

  • Community Based Hospice Care Agency
  • Springdale, AR
  • NPI 1386755460

  Family Medicine

  NPD
• Cooper Clinic PA

  • Multi-Specialty Clinic/Center
  • Fort Smith, AR
  • NPI 1154341931
  NPD (past)
• Mercy Health Northwest Arkansas Communities

  • Multi-Specialty Clinic/Center
  • Rogers, AR
  • NPI 1265490916
  NPD (past)

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713398400000",
    "number": "1831157858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 S 54TH ST STE 4",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588194",
            "telephone_number": "479-268-4504",
            "fax_number": "479-222-0061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2905 S WALTON BLVD",
            "address_2": "SUITE 17",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727126730",
            "telephone_number": "479-657-6501",
            "fax_number": "479-657-6375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVEY",
        "first_name": "TRACI",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-01",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "R4023",
            "primary": true
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "AR",
            "license": "R4023",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "AR",
            "license": "R4023",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117573001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sherry Ireland
• Brittany Irons, DDS
• Scott Sullivan Ironside, PT
• Andrea Shanell Ittner, ATC
• Ivey Family Medicine
• Alyssa D. Ivy, M.S. CCC-SLP
• Joseph J Ivy, M.D.
• J & G Ventures, Inc (BrightStar of Benton County)
• J. Anthony Smith DDS PA
• Katherine Jaber

• Family Medicine Physician in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Family Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.