Kenneth W Stegall, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01795 Issued in TX

Practice address

105 Zeid Blvd BLDG 2
Henderson, TX 75652-6070

Phone

(903) 315-5612

Fax

(903) 657-0139

NPI assigned

Feb 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Physician Assistant

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Christus Trinity Clinic TexasGroup PAC ID 3072426741, 1,540 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Happy at Home Healthcare Home health agency, Henderson, TX, CCN 677275
• Pathfinder Home Health Home health agency, Athens, TX, CCN 453144
• Christus Good Shepherd Home health agency, Longview, TX, CCN 457691
• Vitalcaring Group Home health agency, Henderson, TX, CCN 458072
• Christus Good Shepherd Medical Center Hospital, Longview, TX, CCN 450032
• Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102
• Christus Mother Frances Hospital- Jacksonville Hospital, Jacksonville, TX, CCN 451319

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kstegall7372@christushealth.direct-ci.net

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.

• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225

  TX

  Medicare reassignment Care Compare group NPD
• Mother Frances Hospital Jacksonville

  • Critical Access Hospital
  • Jacksonville, TX
  • NPI 1952306672

  TX

  Medicare reassignment
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD
• Mother Frances Hospital Winnsboro

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1922294867
  NPD (past)
• Trinity Clinic

  • Rural Health Clinic/Center
  • Henderson, TX
  • NPI 1760676613
  NPD (past)

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

• Christus Good Shepherd Medical Center

  • General Acute Care Hospital
  • Longview, TX
  • NPI 1124092036

  Hospital

  Care Compare affiliation
• GSHS Home Health, LLC

  • Home Health Agency
  • Longview, TX
  • NPI 1023128220
  Care Compare affiliation
• Jeff D Miller Investments, LLC

  • Home Health Agency
  • Henderson, TX
  • NPI 1972911964
  Care Compare affiliation
• Mother Frances Hospital Jacksonville

  • Critical Access Hospital
  • Jacksonville, TX
  • NPI 1952306672

  Hospital

  Care Compare affiliation
• Mother Frances Hospital Regional Health Care Center

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439

  Hospital

  Care Compare affiliation
• Northeast Texas Home Health Agency LTD

  • Home Health Agency
  • Henderson, TX
  • NPI 1871632513
  Care Compare affiliation
• Star Care, LLP

  • Home Health Agency
  • Athens, TX
  • NPI 1316950140
  Care Compare affiliation

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1316912470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-324-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 ZEID BLVD BLDG 2",
            "city": "HENDERSON",
            "state": "TX",
            "postal_code": "756526070",
            "telephone_number": "903-315-5612",
            "fax_number": "903-657-0139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEGALL",
        "first_name": "KENNETH",
        "middle_name": "W",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA01795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-017",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "75-2616977-129",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FOR TC",
            "identifier": "8N4367",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mallory Jo Spencer, COTA
• Nicole Leigh Stanley, NP
• Mary J Starling, MD
• Mereline Starling, LVN
• Stay the Day Adult Activity & Health Services Center, Inc
• Angela D Stone, LVN, LPN
• Katherine Elizabeth Stoute
• Strong-Hurt Pharmacy, Inc.
• James C Stroud
• Amber Talley

• Physician Assistant in Henderson, TX
• Providers in Henderson, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.