Stacey Marie Shoop, M.D.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA52143 Issued in CA

Practice address

2621 S Bristol St
Ste 108
Santa Ana, CA 92704-5718

Phone

(714) 754-1684

Fax

(714) 966-0417

NPI assigned

Nov 19, 2014

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 CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Physician Assistant

State licenses

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.

• Coastal Heart, Inc

  • Cardiovascular Disease Physician
  • Santa Ana, CA
  • NPI 1881612828
  Medicare reassignment

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

{
    "created_epoch": "1416355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1104222124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2621 S BRISTOL ST",
            "address_2": "STE 108",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927045718",
            "telephone_number": "714-754-1684",
            "fax_number": "714-966-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 S BRISTOL ST",
            "address_2": "STE 108",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927045718",
            "telephone_number": "714-754-1684",
            "fax_number": "714-966-0417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11263 Stonecress Ave",
            "address_purpose": "LOCATION",
            "city": "Fountain Valley",
            "state": "CA",
            "postal_code": "927082448",
            "country_code": "US",
            "telephone_number": "714-415-8216",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHOOP",
        "first_name": "STACEY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-11-19",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA52143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jan Shoda, RN, PHN
• Homa Shoghian-Shabanpour, M.D
• Leslie Keith Shokes, MD
• Fariba Shokoohy, M.D.
• James Shon, L.AC.
• Arlene H Shorey, RN
• Steven Ting-Bin Shu, PH.D., O.M.D.
• Mark Shugarman, LMFT
• John Sheng Yow Shui, DDS
• Garima Shukla, DMD

• Medical Physician Assistant in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.