Stefani Tica

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

9200 Calumet Ave # 203
Munster, IN 46321-2885

Phone

(219) 228-4200

NPI assigned

Apr 17, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Dermio Dermatology, LLC

  • Dermatology Physician
  • Munster, IN
  • NPI 1811402423
  Medicare reassignment

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

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676332800000",
    "number": "1033739271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9200 CALUMET AVE # 203",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212885",
            "telephone_number": "219-228-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 CALUMET AVE # 203",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463212885",
            "telephone_number": "219-228-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICA",
        "first_name": "STEFANI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-17",
        "last_updated": "2023-02-14",
        "certification_date": "2023-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary John Thomas, DPM
• Nya Simone Thomas
• Kelley Ann Thompson, NNP
• Tiffany A Thurow, DO
• Jordynn Olivia Tibbs, NP
• Vsevolod Tikhomirov, MD
• Mary N Tilak, MD
• Mohammad Tinawi, MD
• Jeffrey Manuel Tioco, M.D.
• Gladys H Tisera

• Physician Assistant in Munster, IN
• Providers in Munster, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.