Active NPI
Stacy Lyn Bishoff
- Community Health Worker
- Freedom, NY
National Provider Identifier
1205171212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 004379-1
- Practice address
- 11622 Scotch Rd
Freedom, NY 14065-9770 - Phone
- (716) 492-0492
- NPI assigned
- Dec 2, 2012
- Last updated
- Dec 2, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 004379-1 | NY | Primary |
Addresses
Primary practice location
11622 Scotch Rd
Freedom, NY 14065-9770
Mailing address
11622 Scotch Rd
Freedom, NY 14065-9770
Phone (716) 492-0492
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004379-1 | NY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354406400000",
"number": "1205171212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11622 SCOTCH RD",
"city": "FREEDOM",
"state": "NY",
"postal_code": "140659770",
"telephone_number": "716-492-0492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11622 SCOTCH RD",
"city": "FREEDOM",
"state": "NY",
"postal_code": "140659770",
"telephone_number": "716-492-0492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BISHOFF",
"first_name": "STACY",
"middle_name": "LYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-02",
"last_updated": "2012-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "NY",
"license": "004379-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Freedom, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.