Alexandra Elizabeth Chacko-Stacey, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

DR.0071257 Issued in CO

Practice address

1760 E Ken Pratt Blvd Ste 201
Longmont, CO 80504-5311

Phone

(720) 718-8222

Fax

(720) 718-0954

NPI assigned

May 6, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

Loma Linda University School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Longs Peak Hospital Hospital, Longmont, CO, CCN 060128

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: astacey96724@direct.llu.edu

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.

• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1225356868

  CO

  Medicare reassignment Care Compare group NPD
• Poudre Valley Medical Group, LLC

  • General Practice Physician
  • Loveland, CO
  • NPI 1366763260

  Obstetrics & Gynecology

  Care Compare group NPD
• Longs Peak Hospital

  • General Acute Care Hospital
  • Longmont, CO
  • NPI 1154876985
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Longs Peak Hospital

  • General Acute Care Hospital
  • Longmont, CO
  • NPI 1154876985

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1557100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1285299206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2695 ROCKY MOUNTAIN AVE STE 150",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 E KEN PRATT BLVD STE 201",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805045311",
            "telephone_number": "720-718-8222",
            "fax_number": "720-718-0954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO-STACEY",
        "first_name": "ALEXANDRA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-06",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CO",
            "license": "DR.0071257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Centennial Womens Health
• Center for Valued Living PLLC
• Philip Joseph Cerdorian, LPC
• Kailey Melissa Cerefin, OTR/L
• Lindsey Pryor Cesca, M.D.
• Annmarie Chaddic, RDH
• Amy Chadwell, MS, OTR/L
• Bryan Young Chai, DDS, PHD
• Katherine Champlin Rice, LPC, MA, LPC
• Sheena Elspet Chand, P.A.

• All providers in Longmont, CO
• Obstetrics & Gynecology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.