Active NPI
Tracy A. Bloom, RN
- Registered Nurse
- Commack, NY
National Provider Identifier
1982747853
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 509923-1
- Practice address
- 62 Pawnee Dr
Commack, NY 11725-4222 - Phone
- (631) 864-6402
- NPI assigned
- Feb 14, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 509923-1 | NY | Primary |
Addresses
Primary practice location
62 Pawnee Dr
Commack, NY 11725-4222
Mailing address
62 Pawnee Dr
Commack, NY 11725-4222
Phone (631) 864-6402
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02365382 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 509923-1 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982747853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "62 PAWNEE DR",
"city": "COMMACK",
"state": "NY",
"postal_code": "117254222",
"telephone_number": "631-864-6402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62 PAWNEE DR",
"city": "COMMACK",
"state": "NY",
"postal_code": "117254222",
"telephone_number": "631-864-6402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLOOM",
"first_name": "TRACY",
"middle_name": "A.",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "509923-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02365382",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Commack, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.