Individual provider Active NPI

Jenna Lee Smith Stout, CM

  • Advanced Practice Midwife
  • Stone Ridge, NY
National Provider Identifier
1295790020
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
F000723 Issued in NY
Practice address
3457 Main St
Stone Ridge, NY 12484-5612
Phone
(845) 430-4300
NPI assigned
Apr 17, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X F000723 NY Primary

Addresses

Primary practice location

3457 Main St
Stone Ridge, NY 12484-5612

Mailing address

334 Plaza Rd
Kingston, NY 12401-2975
Phone (845) 338-5575

Other identifiers 1

IdentifierTypeStateIssuer
F000723OtherNYLICENSE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051027000764 NY Practitioner - Certified Nurse Midwife (CNM) 2567489719 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Medical Care PCGroup PAC ID 9931013240, 1,013 clinicians

Practice addresses (Care Compare)

90 S Bedford Rd
Mount Kisco, NY 10549-3412
Phone (914) 241-1050

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.38 of 100Reported as group
Quality
63.01
Promoting interoperability
98
Improvement activities
40
Cost
72.3

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
000723NYMDMental Health Counselor
F000723NYMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Nov 1, 2024 Accepting new patients
Optum Medical Care, P.C. Advanced Practice Midwife CurrentSince Nov 1, 2024 Accepting new patients
Mount Kisco Medical Group Advanced Practice Midwife Past Accepting new patients

Locations

2322 30th Ave
Astoria, NY 11102
Phone (718) 267-2763

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

45 Reade Pl
Fl 2
Poughkeepsie, NY 12601
Phone (845) 483-6001

Philadelphia, PA 19195

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: jsmithstout161691@direct.optum.com

Organizations & group practices 3

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 1

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": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1295790020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "334 PLAZA RD",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "124012975",
            "telephone_number": "845-338-5575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3457 MAIN ST",
            "city": "STONE RIDGE",
            "state": "NY",
            "postal_code": "124845612",
            "telephone_number": "845-430-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH STOUT",
        "first_name": "JENNA",
        "middle_name": "LEE",
        "credential": "CM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-17",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NY",
            "license": "F000723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "F000723",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stone Ridge, NY

Sources for this page

Verify at the official NPI Registry.