Individual provider Active NPI

Stephanie Kracker, PA-C

  • Physician Assistant
  • Marysville, OH
National Provider Identifier
1316379431
Registry record updated Jun 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.003793 Issued in OH
Practice address
388 Damascus Rd
Marysville, OH 43040-5535
Phone
(937) 578-2626
Fax
(937) 578-2627
NPI assigned
Jul 31, 2013
Last updated
Jun 25, 2019By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.003793 OH Primary

Addresses

Primary practice location

388 Damascus Rd
Marysville, OH 43040-5535

Mailing address

388 Damascus Rd
Marysville, OH 43040-5535
Phone (937) 578-2626

Other practice location 1

140 Colemans Xing
Marysville, OH 43040-7080
Phone (937) 578-2650

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131001000363 OH Practitioner - Physician Assistant 4981838190 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

388 Damascus Rd
Marysville, OH 43040-5535
Phone (937) 578-2626

500 London Ave
Marysville, OH 43040-5512
Phone (937) 578-2275

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.33 of 100Reported as group
Quality
68.93
Promoting interoperability
100
Improvement activities
40
Cost
75.49

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.003793OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Union County Physician Corporation CurrentSince Nov 30, 2015 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

140 Colemans Crossing Blvd
Marysville, OH 43040
Phone (937) 578-2650

388 Damascus Rd
Marysville, OH 43040
Phone (937) 578-2626

500 London Ave
Marysville, OH 43040
Phone (740) 420-8451

500 London Ave
#D
Marysville, OH 43040

500 London Ave
Ste G
Marysville, OH 43040

Interoperability endpoints

  • Direct secure messaging: sgraham889160@direct.osumc.edu

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 4

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": "1375228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1316379431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "388 DAMASCUS RD",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430405535",
            "telephone_number": "937-578-2626",
            "fax_number": "937-578-2627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "388 DAMASCUS RD",
            "city": "MARYSVILLE",
            "state": "OH",
            "postal_code": "430405535",
            "telephone_number": "937-578-2626",
            "fax_number": "937-578-2627"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "140 Colemans Xing",
            "address_purpose": "LOCATION",
            "city": "Marysville",
            "state": "OH",
            "postal_code": "430407080",
            "country_code": "US",
            "telephone_number": "937-578-2650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRACKER",
        "first_name": "STEPHANIE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-07-31",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.003793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marysville, OH

Sources for this page

Verify at the official NPI Registry.