Individual provider Active NPI

Stephanie Ann Connelly, MD

  • Internal Medicine Physician
  • Memphis, TN
National Provider Identifier
1023074382
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
36860 Issued in TN
Practice address
1533 Union Ave
Memphis, TN 38104-3726
Phone
(901) 721-1200
Fax
(901) 721-1212
NPI assigned
Apr 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 36860 TN Primary

Addresses

Primary practice location

1533 Union Ave
Memphis, TN 38104-3726

Mailing address

1211 Union Ave Ste 330
Memphis, TN 38104-6655

Other identifiers 2

IdentifierTypeStateIssuer
4334460OtherTNBCBS
1520957MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20101112000746 TN Practitioner - Internal MedicinePractitioner - Preventive Medicine 3173718327 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Preventive Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Primary Care Group, LLCGroup PAC ID 0941480131, 108 clinicians

Practice addresses (Care Compare)

1533 Union Ave
Memphis, TN 38104-3726
Phone (901) 721-1200

2961 Canada Rd
Suite 105
Lakeland, TN 38002-4893
Phone (901) 388-0115

7690 Wolf River Circle
Germantown, TN 38138-1744
Phone (901) 756-1231

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36860TNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Group LLC Internal Medicine CurrentSince Oct 1, 2012 Accepting new patients
Methodist Healthcare - Memphis Hospitals Past Accepting new patients

Locations

2961 Canada Rd
Ste 105
Lakeland, TN 38002
Phone (901) 388-0115

1211 Union Ave
Ste 700
Memphis, TN 38104
Phone (901) 287-5182

1533 Union Ave
Memphis, TN 38104
Phone (901) 721-1200

1211 Union Ave
Ste 330
Memphis, TN 38104
Phone (901) 478-0954

Networks

  • MS PPO C-SNP
  • MS PPO
  • MS PPO D-SNP

Interoperability endpoints

  • Direct secure messaging: sconnelly32770@mlh.direct-ci.com

Organizations & group practices 2

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 4

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": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746403200000",
    "number": "1023074382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 UNION AVE STE 330",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1533 UNION AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381043726",
            "telephone_number": "901-721-1200",
            "fax_number": "901-721-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "36860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4334460",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1520957",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.