Individual provider Active NPI

Emily J Tracey, PA

  • Physician Assistant
  • Fishersville, VA
National Provider Identifier
1881905263
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110009118 Issued in VA
Practice address
57 Beam LN Ste 202
Fishersville, VA 22939-2350
Phone
(540) 932-0980
Fax
(540) 932-0979
NPI assigned
Jun 30, 2010
Last updated
Sep 11, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0110009118 VA
Physician Assistant 363A00000X 2623-23 WI
Physician Assistant 363A00000X 10955 MN
Physician Assistant 363A00000X 0110009118 VA Primary

Addresses

Primary practice location

57 Beam LN Ste 202
Fishersville, VA 22939-2350

Mailing address

PO Box 9007
Charlottesville, VA 22906-9007

Other names 1

  • Emily R Johnson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20231012001376 VA Practitioner - Physician Assistant 9335273838 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110009118VAMDPediatrics Physician
10955MNMDPhysical Therapist
2623-23WIMDPhysician Assistant
1553MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Virginia Physicians Group CurrentSince Sep 11, 2023 Accepting new patients
Jha MD PC Pediatrics PastSince Sep 17, 2023 Accepting new patients

Locations

1215 Lee St
Fl 8
Charlottesvle, VA 22908
Phone (434) 924-2500

57 Beam Ln
Ste 202
Fishersville, VA 22939
Phone (540) 932-0980

1850 Rosser Ave
Waynesboro, VA 22980
Phone (540) 942-1200

Interoperability endpoints

  • Direct secure messaging: etracey584312@direct.healthsystem.virginia.edu

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.

NPI Registry JSON

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

{
    "created_epoch": "1277856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1881905263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9007",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229069007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 BEAM LN STE 202",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392350",
            "telephone_number": "540-932-0980",
            "fax_number": "540-932-0979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRACEY",
        "first_name": "EMILY",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-30",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0110009118",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2623-23",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10955",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110009118",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "JOHNSON",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fishersville, VA

Sources for this page

Verify at the official NPI Registry.