Individual provider Active NPI

Tracy Schubert

  • Registered Dietitian
  • Clinton, MO
National Provider Identifier
1912397902
Registry record updated Feb 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
2004033387 Issued in MO
Practice address
1600 N 2ND St
Clinton, MO 64735-1192
Phone
(660) 890-7083
NPI assigned
Jan 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 2004033387 MO Primary

Addresses

Primary practice location

1600 N 2ND St
Clinton, MO 64735-1192

Mailing address

1600 N 2ND St
Clinton, MO 64735-1192
Phone (660) 890-7083

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160812002216 MO Practitioner - Registered Dietitian Or Nutrition Professional 6002100047 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Golden Valley Memorial Hospital DistrictGroup PAC ID 4688561814, 138 clinicians

Practice addresses (Care Compare)

1600 N 2ND St
Clinton, MO 64735-1192
Phone (660) 885-5511

Hospital & facility affiliations

  • Golden Valley Memorial Hospital Hospital, Clinton, MO, CCN 260175

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2004033387MOMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Golden Valley Memorial Hospital District CurrentSince Jun 19, 2016 Accepting new patients
Golden Valley Memorial Hospital District Current Accepting new patients
Golden Valley Memorial Hospital District CurrentSince Jun 19, 2016 Accepting new patients

Locations

1600 N 2nd St
Clinton, MO 64735
Phone (660) 885-8171

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1422403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581984000000",
    "number": "1912397902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-890-7083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 N 2ND ST",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647351192",
            "telephone_number": "660-890-7083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHUBERT",
        "first_name": "TRACY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-28",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MO",
            "license": "2004033387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.