Individual provider Active NPI

Jill Lynne Stefanucci-Uberti, DO

  • Emergency Medicine Physician
  • Warren, OH
National Provider Identifier
1104157973
Registry record updated Jan 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
34.009758 Issued in OH
Practice address
667 Eastland Ave SE
Warren, OH 44484-4503
Phone
(330) 841-4029
NPI assigned
Jan 19, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 34.009758 OH Primary

Addresses

Primary practice location

667 Eastland Ave SE
Warren, OH 44484-4503

Mailing address

2757 Stoney Creek CT
Hermitage, PA 16148-7341
Phone (724) 979-4567

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20100421000051 OH Practitioner - Emergency Medicine 3072640226 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
4M Emergency Systems LLCGroup PAC ID 7719882182, 29 clinicians

Practice addresses (Care Compare)

667 Eastland Ave SE
Warren, OH 44484-4503
Phone (330) 841-4000

Hospital & facility affiliations

  • MH St Joseph Warren Hospital Hospital, Warren, OH, CCN 360161

Merit-based Incentive Payment System (MIPS)

Final score
84.13 of 100Reported as group
Quality
79.67
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Physician Assistant

State licenses

LicenseStateTypeSpecialty
34.009758OHMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mves Boardman LLC Emergency Medicine CurrentSince Jul 7, 2021 Accepting new patients
4M Emergency Systems LLC Emergency Medicine CurrentSince Feb 15, 2010 Accepting new patients
4M Emergency Systems Tod LLC Emergency Medicine CurrentSince Sep 15, 2022 Accepting new patients
Mercy Health Youngstown LLC PastSince Sep 15, 2022 Accepting new patients

Locations

667 Eastland Ave SE
Warren, OH 44484
Phone (330) 841-2378

1296 Tod Pl NW
Ste 200
Warren, OH 44485
Phone (330) 306-5040

1950 Niles Cortland Rd NE
Warren, OH 44484
Phone (234) 600-5752

8401 Market St
Youngstown, OH 44512
Phone (330) 729-2929

Interoperability endpoints

  • Direct secure messaging: jstefanucciuberti35210@direct.bsmhealth.org

Organizations & group practices 4

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 2

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": "1263859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263859200000",
    "number": "1104157973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2757 STONEY CREEK CT",
            "city": "HERMITAGE",
            "state": "PA",
            "postal_code": "161487341",
            "telephone_number": "724-979-4567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "667 EASTLAND AVE SE",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444844503",
            "telephone_number": "330-841-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEFANUCCI-UBERTI",
        "first_name": "JILL",
        "middle_name": "LYNNE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-19",
        "last_updated": "2010-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "34.009758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, OH

Sources for this page

Verify at the official NPI Registry.