Individual provider Active NPI

Stephen Warren Hartzell, MD PHD

  • Ophthalmology Physician
  • Clyde, NC
National Provider Identifier
1114913522
Registry record updated Aug 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
9900863 Issued in NC
Practice address
486 Hospital Dr
Clyde, NC 28721-8026
Phone
(828) 452-5816
Fax
(828) 452-0373
NPI assigned
Sep 21, 2005
Last updated
Aug 25, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 9900863 NC Primary

Addresses

Primary practice location

486 Hospital Dr
Clyde, NC 28721-8026

Mailing address

486 Hospital Dr
Clyde, NC 28721-8026
Phone (828) 452-5816

Other identifiers 1

IdentifierTypeStateIssuer
891233JMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9900863NCMDOphthalmology Physician

NPI Registry JSON

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314230400000",
    "number": "1114913522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "486 HOSPITAL DR",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287218026",
            "telephone_number": "828-452-5816",
            "fax_number": "828-452-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "486 HOSPITAL DR",
            "city": "CLYDE",
            "state": "NC",
            "postal_code": "287218026",
            "telephone_number": "828-452-5816",
            "fax_number": "828-452-0373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTZELL",
        "first_name": "STEPHEN",
        "middle_name": "WARREN",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2011-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NC",
            "license": "9900863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891233J",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clyde, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.