NPIMap

Individual provider Active NPI

Stacy L Gittler, P.A.

  • Surgical Physician Assistant
  • Richmond, VA
National Provider Identifier
1295743847
Registry record updated Mar 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
0110002656 Issued in VA
Practice address
5855 Bremo Rd
Suite 406
Richmond, VA 23226-1930
Phone
(804) 285-4133
Fax
(804) 622-2224
NPI assigned
Aug 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X MA052610 PA
Surgical Physician Assistant 363AS0400X 0110002656 VA Primary

Addresses

Primary practice location

5855 Bremo Rd
Suite 406
Richmond, VA 23226-1930

Mailing address

5855 Bremo Rd
Suite 406
Richmond, VA 23226-1930
Phone (804) 285-4133

Other identifiers 2

IdentifierTypeStateIssuer
C06778OtherVAGROUP PTAN
C06695OtherVAGROUP PTAN

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
I20090918000341 VA Practitioner - Physician Assistant 3274528682 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bon Secours Medical Group Richmond Specialty Care LLCGroup PAC ID 8022440056, 350 clinicians
Vituity-Virginia Hospitalists PCGroup PAC ID 6507245131, 109 clinicians

Practice addresses (Care Compare)

1510 N 28TH St
Richmond, VA 23223-5311

5801 Bremo Rd
Richmond, VA 23226-1907
Phone (804) 285-2011

Hospital & facility affiliations

  • Bon Secours St Marys Hospital Hospital, Richmond, VA, CCN 490059

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA052610PAMDSurgical Physician Assistant
0110002656VAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Jan 1, 2020 Accepting new patients
Bon Secours Medical Group Richmond Specialty Care LLC CurrentSince Jan 1, 2020 Accepting new patients
Bon Secours-Virginia Healthsource Inc Past Accepting new patients
Bon Secours-St. Mary'S Hospital of Richmond, Inc. Past Accepting new patients
Bon Secours-St. Mary'S Hospital of Richmond, Inc. Past Accepting new patients
Bon Secours-St. Mary'S Hospital of Richmond, Inc. Past Accepting new patients

Locations

5855 Bremo Rd
Ste 506
Richmond, VA 23226
Phone (804) 285-3225

8580 Magellan Pkwy
Richmond, VA 23227
Phone (804) 627-5462

5855 Bremo Rd
Ste 406
Richmond, VA 23226
Phone (804) 285-4133

5855 Bremo Rd
Ste 306
Richmond, VA 23226
Phone (804) 287-7644

5801 Bremo Rd
Richmond, VA 23226
Phone (804) 281-8220

1510 N 28th St
Ste 110
Richmond, VA 23223
Phone (804) 545-2304

1362 Tappahannock Blvd
Tappahannock, VA 22560
Phone (804) 443-5378

Interoperability endpoints

  • Direct secure messaging: sgittler1151440@direct.bsmhealth.org

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 6

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": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331510400000",
    "number": "1295743847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5855 BREMO RD",
            "address_2": "SUITE 406",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232261930",
            "telephone_number": "804-285-4133",
            "fax_number": "804-622-2224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5855 BREMO RD",
            "address_2": "SUITE 406",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232261930",
            "telephone_number": "804-285-4133",
            "fax_number": "804-622-2224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GITTLER",
        "first_name": "STACY",
        "middle_name": "L",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2012-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA052610",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "VA",
            "license": "0110002656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06778",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "C06695",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.