Stacey A Summers

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS015838 Issued in PA

Practice address

1601 Walnut St Ste 1017
Philadelphia, PA 19102-2906

Phone

(215) 564-0488

Fax

(215) 564-1245

NPI assigned

Nov 29, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Senior Care Therapy of Pennsylvania PCGroup PAC ID 2264791268, 28 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Senior Care Therapy of Pennsylvania, P.C.

  • Clinical Social Worker
  • Prospect Park, PA
  • NPI 1003320672
  Medicare reassignment Care Compare group NPD
• The Men's Resource Center

  • Clinical Social Worker
  • Philadelphia, PA
  • NPI 1730292277
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1023290236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 WALNUT ST STE 1017",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022906",
            "telephone_number": "215-564-0488",
            "fax_number": "215-564-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 WALNUT ST STE 1017",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191022906",
            "telephone_number": "215-564-0488",
            "fax_number": "215-564-1245"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 Chester Pike",
            "address_purpose": "LOCATION",
            "city": "Prospect Park",
            "state": "PA",
            "postal_code": "190762322",
            "country_code": "US",
            "telephone_number": "973-264-0023",
            "fax_number": "973-264-0022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SUMMERS",
        "first_name": "STACEY",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-29",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS015838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017489680001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ross S Summer, M.D.
• Amanda E Summers, MD
• Deborah A. Summers, PA-C
• Mahogany Summers
• Odessa L Summers
• Jacquelyn Renee Summerset, PT
• Lauren Summerton, PT, DPT
• Susan L. Summerton, M.D.
• Robert D Summey, MD
• Summit Care Medical Supply

• Psychologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.