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TRACY-JANE LUYUN FAJOTA AGACNP-BC
NPI 1700660560
Nurse Practitioner - Acute Care in Glendale, CA

Active since August 22, 2023PECOS EnrolledAccepts Medicare Assignment
1420 S CENTRAL AVE, GLENDALE, CA 91204(818) 502-1900 Get Directions Write a Review

NPPES record last updated: August 22, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Tracy-jane Luyun Fajota Agacnp-bc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRACY-JANE LUYUN FAJOTA AGACNP-BC (NPI 1700660560) is an individual acute care provider in Glendale, California, licensed in California (95025937) and active in the NPI registry since August 2023. She is enrolled in Medicare PECOS, maintains a secondary practice location in Northridge, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1700660560
Entity TypeIndividualFemale
Primary Taxonomy363LA2100X
Provider Legal NameTRACY-JANE LUYUN FAJOTACredential: AGACNP-BC
Location Address1420 S CENTRAL AVEGlendale, CA 91204-2508
Mailing Address8510 Balboa Blvd Ste 150Northridge, CA 91325-5810 · (818) 636-0501
Phone(818) 502-1900
Sole ProprietorNo
Medical School CMSOtherGraduated 2023
Enumeration DateAugust 22, 2023
NPPES CertifiedAugust 22, 2023
✔ NPI 1700660560 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in CA · 95025937
1420 S CENTRAL AVE, Glendale, CA 91204
Open in Google Maps ↗

Secondary Practice Location 1

Location 18510 Balboa Blvd Ste 150Northridge, CA 91325-5810 · Phone (818) 654-3400

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tracy-jane Luyun Fajota Agacnp-bc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3173978194
PECOS Enrollment IDI20231011003343
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Tracy-jane Fajota reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Antaki & Associates Infectious Disease Medical Group Inc
0.8 mi
Infectious Disease
801 S CHEVY CHASE DR, 101
Glendale, CA 91205
  • Reassigned Medicare billing, California enrollment
  • 7 clinicians in this Medicare group
NPI 1124083274 (818) 242-5299
Lakeside Medical Organization, A Medical Group Inc.
22 mi
Internal Medicine
8501 FALLBROOK AVE STE 300
West Hills, CA 91304
  • Reassigned Medicare billing, California enrollment
  • 205 clinicians in this Medicare group
NPI 1831426642 (818) 654-3400

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 91204 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$109.96 typical visit price
range $20.84 – $153.61
Typical copayment $27.49 (range $5.21 – $38.40)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ELOISE KOWAL SLP
Speech-Language Pathologist
1420 S CENTRAL AVE
GLENDALE, CA 91204
Los Angeles County (818) 502-1900
GREGORY G LARA MD INC
Anesthesiology
1420 S CENTRAL AVE
GLENDALE, CA 91204
Los Angeles County (818) 502-1900
DR. JOSIAH FRIEDLANDER M.D.
Emergency Medicine
1420 S CENTRAL AVE
GLENDALE, CA 91204
Los Angeles County (818) 502-2344
MS. CAROLYN TORRES
Student in an Organized Health Care Education/Training Program
1420 S CENTRAL AVE
GLENDALE, CA 91204
Los Angeles County (818) 502-1900
HEATHER HARTSHORN PT
Physical Therapist
1420 S CENTRAL AVE
GLENDALE, CA 91204
Los Angeles County (818) 502-2330
ALLEN BEST, M.D., INC.
Anesthesiology
1420 S CENTRAL AVE
GLENDALE, CA 91204
Los Angeles County (818) 502-1900
ROY H. MOFFATT, M.D., INC
Pathology (Anatomic Pathology & Clinical Pathology)
1420 S CENTRAL AVE
GLENDALE, CA 91204
Los Angeles County (818) 502-2321
ARISTOTLE NOBLEZA ARIOLA
Registered Nurse (Psychiatric/Mental Health, Adult)
1420 S CENTRAL AVE
GLENDALE, CA 91204
Los Angeles County (818) 502-2362

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tracy-jane Fajota's NPI number?

The NPI number for Tracy-jane Fajota is 1700660560. It was assigned to this individual provider in the NPPES registry on August 22, 2023.

Where is Tracy-jane Fajota located?

Tracy-jane Fajota practices at 1420 S Central Ave, Glendale, CA 91204. The listed phone number is (818) 502-1900.

What is Tracy-jane Fajota's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is Tracy-jane Fajota enrolled in Medicare?

Yes. Tracy-jane Fajota is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Tracy-jane Fajota's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tracy-jane Fajota reassigns Medicare benefits to 2 organizations: Antaki & Associates Infectious Disease Medical Group Inc (Glendale, CA) and Lakeside Medical Organization, A Medical Group Inc. (West Hills, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tracy-jane Fajota's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Tracy-jane Fajota was last updated on August 22, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.