NPIMap

Individual provider Active NPI

Tracy Nicole Clouser, CRNP

  • Family Nurse Practitioner
  • Wyomissing, PA
National Provider Identifier
1831698158
Registry record updated Jul 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP018561 Issued in PA
Practice address
2607 Keiser Blvd
Wyomissing, PA 19610-3338
Phone
(610) 743-3139
Fax
(610) 743-3143
NPI assigned
Feb 2, 2018
Last updated
Jul 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP018561 PA Primary

Addresses

Primary practice location

2607 Keiser Blvd
Wyomissing, PA 19610-3338

Mailing address

248 Ziegler Rd
Leesport, PA 19533-9413
Phone (610) 780-0903

Other names 1

  • Tracy Nicole Donatelli Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20180320001408 PA Practitioner - Nurse Practitioner 0547522179 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians
St Joseph Medical GroupGroup PAC ID 3779688650, 190 clinicians

Practice addresses (Care Compare)

2000 Westinghouse Dr
Suite 200
Cranberry Township, PA 16066-5238

2607 Keiser Blvd
Suite 100
Wyomissing, PA 19610-3326
Phone (610) 743-3139

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.31 of 100Reported as group
Quality
55.01
Promoting interoperability
99
Improvement activities
40
Cost
76.86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
SP018561PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph Medical Group Current Accepting new patients
St. Joseph Medical Group CurrentSince Feb 19, 2018 Accepting new patients

Locations

2500 Bernville Rd
Reading, PA 19605
Phone (610) 378-2300

2607 Keiser Blvd
Wyomissing, PA 19610
Phone (610) 743-3139

2607 Keiser Blvd
Ste 100
Wyomissing, PA 19610
Phone (610) 743-3139

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1517529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625270400000",
    "number": "1831698158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 ZIEGLER RD",
            "city": "LEESPORT",
            "state": "PA",
            "postal_code": "195339413",
            "telephone_number": "610-780-0903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2607 KEISER BLVD",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196103338",
            "telephone_number": "610-743-3139",
            "fax_number": "610-743-3143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLOUSER",
        "first_name": "TRACY",
        "middle_name": "NICOLE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-02",
        "last_updated": "2021-07-03",
        "certification_date": "2021-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP018561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "DONATELLI",
            "middle_name": "NICOLE",
            "credential": "CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wyomissing, PA

Sources for this page

Verify at the official NPI Registry.