Tracy Jungman, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

56035 Issued in ID

Practice address

417 S 6TH St
Boise, ID 83702-7632

Phone

(208) 577-4460

Fax

(208) 577-4469

NPI assigned

May 26, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Tracy Wallace Former name

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058
  Medicare reassignment NPD
• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Mountain Home, ID
  • NPI 1417297821
  NPD
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  NPD (past)

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

{
    "created_epoch": "1495756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1841728342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3561 N LA FONTANA WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837021526",
            "telephone_number": "208-409-3972",
            "fax_number": "208-381-6870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 S 6TH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027632",
            "telephone_number": "208-577-4460",
            "fax_number": "208-577-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUNGMAN",
        "first_name": "TRACY",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-05-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "56035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACY",
            "last_name": "WALLACE",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christie A Julian, MD
• Shauna Julian, LCPC
• Julie a Conyers, M.D. PA
• Naomie Julugbeh
• Nicole Jund
• Darin Jurgensmeier, MD
• Just for Today Sober Living Inc
• Dalana Justesen-Baxter, LCSW
• Nicole Marie Justesen
• Ronald E Jutzy, MD

• Nurse Practitioner in Boise, ID
• Providers in Boise, ID by specialty
• Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.