Individual provider Active NPI

Tracy Jansen, M.D.

  • Family Medicine Physician
  • Pasadena, MD
National Provider Identifier
1922031210
Registry record updated Jan 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0062357 Issued in MD
Practice address
24A Magothy Beach Rd
Pasadena, MD 21122-4428
Phone
(410) 255-2700
Fax
(410) 437-1962
NPI assigned
Jul 9, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X D0062357 MD Primary

Addresses

Primary practice location

24A Magothy Beach Rd
Pasadena, MD 21122-4428

Mailing address

1111 Benfield Blvd
Suite 200
Millersville, MD 21108-3002
Phone (410) 729-5100

Other identifiers 11

IdentifierTypeStateIssuer
132272OtherMDJHHC PROVIDER NUMBER
1438610OtherMDAETNA CAPITATED
3576324OtherCIGNA PIN
646211-03OtherMDCAREFIRST MD RENDERING
7605-0088OtherMDCAREFIRST BLUECHOICE
8167140OtherMDMAMSI PRIMARY CARE
2167140OtherMDMAMSI SPECIALIST
P17639OtherMDCAREFIRST MD POS
P00388727OtherMDRR MEDICARE
407728800MedicaidMD
5221541OtherMDAETNA FEE FOR SERVICE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051022000181 MD Practitioner - Family Practice 2860418449 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Virginia Commonwealth University, School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Maryland Primary Care Physicians, LLCGroup PAC ID 8729981832, 101 clinicians

Practice addresses (Care Compare)

24 Magothy Beach Rd
Suite a
Pasadena, MD 21122-4414
Phone (410) 255-2700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0062357MDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maryland Primary Care Physicians, LLC CurrentSince Dec 4, 2006 Accepting new patients
Potomac Physicians PA Family Medicine Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1509 Ritchie Hwy
Arnold, MD 21012
Phone (410) 757-1600

1111 Benfield Blvd
Ste 200
Millersville, MD 21108
Phone (410) 729-5100

24 Magothy Beach Rd
Ste A
Pasadena, MD 21122
Phone (410) 255-2700

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 5

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": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295827200000",
    "number": "1922031210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 BENFIELD BLVD",
            "address_2": "SUITE 200",
            "city": "MILLERSVILLE",
            "state": "MD",
            "postal_code": "211083002",
            "telephone_number": "410-729-5100",
            "fax_number": "410-729-5156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24A MAGOTHY BEACH RD",
            "city": "PASADENA",
            "state": "MD",
            "postal_code": "211224428",
            "telephone_number": "410-255-2700",
            "fax_number": "410-437-1962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANSEN",
        "first_name": "TRACY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2011-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0062357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JHHC PROVIDER NUMBER",
            "identifier": "132272",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA CAPITATED",
            "identifier": "1438610",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PIN",
            "identifier": "3576324",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MD RENDERING",
            "identifier": "646211-03",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUECHOICE",
            "identifier": "7605-0088",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI PRIMARY CARE",
            "identifier": "8167140",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI SPECIALIST",
            "identifier": "2167140",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MD POS",
            "identifier": "P17639",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00388727",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "407728800",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA FEE FOR SERVICE",
            "identifier": "5221541",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, MD

Sources for this page

Verify at the official NPI Registry.