TRACY M HAZELTON (PA-C) – Medical Physician Assistant, NPI 1821024746
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
10,570 PHYSICIAN ASSISTANT in CA
Provider Addresses for TRACY M HAZELTON (PA-C)
925 Bevins Court
Lakeport, CA 954539754
Phone: (707) 263-8383
Fax: (707) 263-5019
Type: Location
Lakeshore Drive, Clearlake Park, Clearlake, Lake County, California, 95422, United States
SUITE 101
CLEARLAKE, CA 954229814
Phone: (707) 995-1362
Fax: (707) 995-1362
Type: Mailing
PO BOX 1950
LAKEPORT, CA 954531950
Phone: (707) 263-8382
Fax: (707) 263-1909
Type: Mailing
14440 OLYMPIC DRIVE
CLEARLAKE, CA 954228809
Phone: (707) 263-8383
Fax: (707) 263-5019
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $13.
Total Amount is formed as General ($13) + Research ($0) + Ownership ($0) = $13.
Last reported payment date: 2023-10-18 • Largest payer in this snapshot: Novo Nordisk Inc ($13).
Total Amount
$13
General + Research + Ownership
Payments
1
Total payment records
General Amount
$13
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-10-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novo Nordisk Inc | $13 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2006-04-18
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20060418000211 | I | Physician Assistant | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 95453)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Marriage And Family Therapist | CA | |
| Family Practice | CA | |
| Physical Medicine And Rehabilitation | CO | |
| Marriage And Family Therapist | CA | |
| Family Practice | CA | |
| Anesthesiology, Pain Management | CA | |
| O P H T H A L M O L O G Y | IA | |
| Clinical Social Worker | MD | |
| - | CA | |
| Clinical Social Worker | CA |
Reviews
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