Individual provider Active NPI

Kristin Leanne Stevens, M.D.

  • Otolaryngology Physician
  • Mt Juliet, TN
National Provider Identifier
1033598669
Registry record updated Jun 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
60828 Issued in TN
Practice address
325 Old Pleasant Grove Rd
Mt Juliet, TN 37122-4493
Phone
(629) 255-2263
Fax
(629) 255-4209
NPI assigned
May 28, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Otolaryngology Physician 207Y00000X 60828 TN Primary

Addresses

Primary practice location

325 Old Pleasant Grove Rd
Mt Juliet, TN 37122-4493

Mailing address

222 22ND Ave N
Nashville, TN 37203-1852
Phone (629) 255-3486

Other identifiers 1

IdentifierTypeStateIssuer
60828MedicaidTN

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
I20200807002202 TN Practitioner - Otolaryngology 2567766181 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Vanderbilt University School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Heritage Medical Associates PCGroup PAC ID 4688651037, 162 clinicians

Practice addresses (Care Compare)

5653 Frist Blvd
Suite 630
Hermitage, TN 37076-2094
Phone (629) 255-2097

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Heritage Medical Associates PC CurrentSince Sep 1, 2020 Accepting new patients
Heritage Medical Associates PC CurrentSince Sep 1, 2020 Accepting new patients

Locations

5653 Frist Blvd
Ste 630
Hermitage, TN 37076
Phone (615) 391-3971

325 Old Pleasant Grove Rd
Mt Juliet, TN 37122
Phone (629) 255-3486

222 22nd Ave N
Nashville, TN 37203
Phone (629) 255-2620

Interoperability endpoints

  • Direct secure messaging: kristinstevens@hma.allscriptsdirect.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1432771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1033598669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 22ND AVE N",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031852",
            "telephone_number": "629-255-3486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 OLD PLEASANT GROVE RD",
            "city": "MT JULIET",
            "state": "TN",
            "postal_code": "371224493",
            "telephone_number": "629-255-2263",
            "fax_number": "629-255-4209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "KRISTIN",
        "middle_name": "LEANNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-28",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TN",
            "license": "60828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60828",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Juliet, TN

Sources for this page

Verify at the official NPI Registry.