Tracy M. Creel, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA064 Issued in MS

Practice address

411 Webster St
Wildwood, FL 34785-4036

Phone

(352) 748-6689

Fax

(352) 748-6381

NPI assigned

Nov 18, 2005

Last updated

Mar 21, 2011By 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 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Rural Medical Associates Inc

  dba Wildwood Medical Center

  • Rural Health Clinic/Center
  • Wildwood, FL
  • NPI 1770570806
  NPD (past)

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300665600000",
    "number": "1871575324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 WEBSTER ST",
            "city": "WILDWOOD",
            "state": "FL",
            "postal_code": "347854036",
            "telephone_number": "352-748-6689",
            "fax_number": "352-748-6381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 WEBSTER ST",
            "city": "WILDWOOD",
            "state": "FL",
            "postal_code": "347854036",
            "telephone_number": "352-748-6689",
            "fax_number": "352-748-6381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREEL",
        "first_name": "TRACY",
        "middle_name": "M.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-18",
        "last_updated": "2011-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MS",
            "license": "PA064",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9103034",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001311700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUESHIELD",
            "identifier": "Y0139",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03729301",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Comfortable Care Dental Health Professionals, P.a. (The Crossroads Dental CarE)
• Compass DPT, LLC (FYZICAL The Villages)
• Christine Marie Connell, CPHT
• Santiago Corrales Delgado I
• CR 125, LLC (Generations Senior Living at The Fairways)
• Ana Cristina Cruz, DC
• Angelo Anthony Darby, H.A.S.
• Miguel J. De Puigdorfila
• Neil Ivan Delos Reyes, PA-C
• Christine D Diaz

• Medical Physician Assistant in Wildwood, FL
• Providers in Wildwood, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; 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.