NPIMap

Individual provider Active NPI

Stacey Chung, PA-C

  • Physician Assistant
  • Boston, MA
National Provider Identifier
1184385064
Registry record updated May 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA8638 Issued in MA
Practice address
830 Harrison Avenue, 3Rd FL
Moakley BLDG
Boston, MA 02118-2690
Phone
(617) 638-6428
Fax
(617) 638-5756
NPI assigned
Jan 4, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA8638 MA Primary

Addresses

Primary practice location

830 Harrison Avenue, 3Rd FL
Moakley BLDG
Boston, MA 02118-2690

Mailing address

960 Massachusetts Avenue
FL 2
Boston, MA 02118-2690

Other practice location 1

479 Washington St Ste 2
Quincy, MA 02169-5895
Phone (857) 529-5220

Other identifiers 2

IdentifierTypeStateIssuer
3141609MedicaidMA
11091269AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221024000997 MA Practitioner - Physician Assistant 1355717943 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Evans Medical Foundation IncGroup PAC ID 7416946546, 525 clinicians

Practice addresses (Care Compare)

1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone (617) 638-8000

72 E Newton St
CR Evans 124
Boston, MA 02118-2308
Phone (617) 638-7253

88 E Newton St
Boston, MA 02118-2308
Phone (617) 414-5405

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Convenientmd - FFS UC LLC CurrentSince Aug 26, 2023 Accepting new patients
Convenientmd - FFS UC LLC CurrentSince Aug 26, 2023 Accepting new patients
Boston Medical Center Corporation Current Accepting new patients
Convenientmd LLC Past Accepting new patients
Convenientmd LLC PastSince Mar 1, 2022 Accepting new patients

Locations

245 Hartford Ave
Bellingham, MA 02019
Phone (774) 295-4355

960 Massachusetts Ave
Ste 2
Boston, MA 02118

40 Davis Straits
Falmouth, MA 02540
Phone (774) 255-3010

479 Washington St
Ste 2
Quincy, MA 02169
Phone (857) 529-5220

111 New Hampshire Ave
Portsmouth, NH 03801

360 US Highway 1 Byp
Unit 102
Portsmouth, NH 03801
Phone (603) 410-6700

Interoperability endpoints

  • Direct secure messaging: schung179930@direct.bmc.masshiway.net

Organizations & group practices 7

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 8

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": "1641254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779235200000",
    "number": "1184385064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVENUE",
            "address_2": "FL 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 HARRISON AVENUE, 3RD FL",
            "address_2": "MOAKLEY BLDG",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690",
            "telephone_number": "617-638-6428",
            "fax_number": "617-638-5756"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "479 Washington St Ste 2",
            "address_purpose": "LOCATION",
            "city": "Quincy",
            "state": "MA",
            "postal_code": "021695895",
            "country_code": "US",
            "telephone_number": "857-529-5220",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "STACEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-04",
        "last_updated": "2026-05-20",
        "certification_date": "2026-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA8638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3141609",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11091269A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.