NPIMap

Individual provider Active NPI

Stacy L. Street, M.D.

  • Surgery Physician
  • Richmond, VA
National Provider Identifier
1275566234
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
0101267297 Issued in VA
Practice address
1250 E Marshall St
Richmond, VA 23298-5051
Phone
(601) 426-4739
NPI assigned
Jul 9, 2006
Last updated
Sep 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 0101267297 VA Primary

Addresses

Primary practice location

1250 E Marshall St
Richmond, VA 23298-5051

Mailing address

PO Box 91734
Richmond, VA 23291-1734
Phone (855) 689-5105

Other practice location 1

11958 W Broad St
Henrico, VA 23233-1007
Phone (804) 775-4500

Other practice location 2

9109 Stony Point Dr
Richmond, VA 23235-1979
Phone (804) 775-4500

Other practice location 3

417 N 11th St
Richmond, VA 23298-5024
Phone (803) 828-7069

Other identifiers 1

IdentifierTypeStateIssuer
00186342MedicaidMS

Other names 1

  • Stacey L. Smithers Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20190830002180 VA Practitioner - General Surgery 2860442027 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Practice addresses (Care Compare)

1250 E Marshall St
Richmond, VA 23219-5051
Phone (804) 828-9000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.95 of 100Reported as group
Quality
69.91
Promoting interoperability
99
Improvement activities
40
Cost
77.42

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue204
Removal of skin lesions23
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
23004SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Healogics Specialty Physicians of Virginia, LLC CurrentSince Aug 5, 2019 Accepting new patients
MCV Associated Physicians CurrentSince Jun 29, 2020 Accepting new patients

Locations

1220 Jefferson St
Laurel, MS 39440
Phone (601) 426-4000

11803 Jefferson Ave
Newport News, VA 23606
Phone (757) 594-1000

11958 W Broad St
Richmond, VA 23233
Phone (804) 360-4669

1250 E Marshall St
Richmond, VA 23298
Phone (804) 628-6990

401 N 11th St
Richmond, VA 23219
Phone (804) 828-4409

417 N 11th St
Richmond, VA 23298
Phone (804) 828-0733

9109 Stony Point Dr
Richmond, VA 23235
Phone (804) 323-0830

400 Sentara Cir
Williamsburg, VA 23188
Phone (757) 345-4080

14010 Smoketown Rd
Ste 103
Woodbridge, VA 22192
Phone (571) 402-7322

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1275566234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 91734",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232911734",
            "telephone_number": "855-689-5105",
            "fax_number": "888-507-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 E MARSHALL ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232985051",
            "telephone_number": "601-426-4739"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11958 W Broad St",
            "address_purpose": "LOCATION",
            "city": "Henrico",
            "state": "VA",
            "postal_code": "232331007",
            "country_code": "US",
            "telephone_number": "804-775-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9109 Stony Point Dr",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232351979",
            "country_code": "US",
            "telephone_number": "804-775-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "417 N 11th St",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "VA",
            "postal_code": "232985024",
            "country_code": "US",
            "telephone_number": "803-828-7069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STREET",
        "first_name": "STACY",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "VA",
            "license": "0101267297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00186342",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "SMITHERS",
            "middle_name": "L.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.