TRACY BOSANKO (PMHNP) – Adult Psychiatric/Mental Health Registered Nurse, NPI 1184445264
Adult Psychiatric/Mental Health Registered Nurse
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,105 NURSE PRACTITIONER in MI
Provider Addresses for TRACY BOSANKO (PMHNP)
5842 HATHAWAY RD
CANTON, MI 481875609
Phone: (734) 536-3043
Type: Mailing
17177 N LAUREL PARK DR STE 131
LIVONIA, MI 481523952
Phone: (734) 462-3210
Fax: (734) 462-1024
Type: Location
5842 Hathaway Rd
Canton, MI 481875609
Phone: (734) 536-3043
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 $112.
Total Amount is formed as General ($112) + Research ($0) + Ownership ($0) = $112.
Last reported payment date: 2024-10-02 • Largest payer in this snapshot: Axsome Therapeutics, Inc. ($112).
Total Amount
$112
General + Research + Ownership
Payments
1
Total payment records
General Amount
$112
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-02
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Axsome Therapeutics, Inc. | $112 |
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: 2025-01-22
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 |
|---|---|---|---|---|
| I20250122002742 | I | Nurse Practitioner | MI | 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 48187)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Clinical Social Worker | MI | |
| Clinical Social Worker | MI | |
| - | WA | |
| Physician Assistant | MI | |
| - | MI | |
| Clinical Psychologist | MI | |
| - | MI | |
| Certified Clinical Nurse Specialist (Cns), Nurse Practitioner | IN | |
| P S Y C H I A T R Y | MI | |
| Nurse Practitioner | OH |
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