Erick Stafford, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1191813 Issued in TN

Practice address

30 Sandstone Cir
Jackson, TN 38305-2073

Phone

(731) 240-1695

Fax

(731) 240-1694

NPI assigned

Feb 24, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

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

State licenses

Practice roles

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.

• Cardiovascular Clinic of West TN PC

  • Cardiovascular Disease Physician
  • Jackson, TN
  • NPI 1740480961
  Medicare reassignment
• The Cardiovascular Clinic of West Tennessee,P.C.

  • Cardiovascular Disease Physician
  • Jackson, TN
  • NPI 1013112457
  NPD (past)

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

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646265600000",
    "number": "1053067405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9036 WEEPING CHERRY LN",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380165373",
            "telephone_number": "813-796-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 SANDSTONE CIR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052073",
            "telephone_number": "731-240-1695",
            "fax_number": "731-240-1694"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9036 Weeping Cherry Ln",
            "address_purpose": "LOCATION",
            "city": "Cordova",
            "state": "TN",
            "postal_code": "380165373",
            "country_code": "US",
            "telephone_number": "813-796-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAFFORD",
        "first_name": "ERICK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-24",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "1191813",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1191813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Paschall Spurgeon, PT
• Omar Srour, MD
• Tiffany Latese Stackens
• Staffco of Southwest TN, LLC. Dba at Home Healthcare of Southwest TN
• Amber Lynn Stafford, CRNA
• Kayce Stafford, OTA
• Adrean Raquel Stamper, DNP
• Jennifer Standoff, LMSW
• Rebecca S Stanfield, LSPE
• Reba Stanley, RBT

• Physician Assistant in Jackson, TN
• Providers in Jackson, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; 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.