NPIMap

Individual provider Active NPI

Stefan John Stefanovich Jr., PA

  • Physician Assistant
  • Cambridge, NY
National Provider Identifier
1326039769
Registry record updated Jun 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
006413 Issued in NY
Practice address
35 Gilbert St
Cambridge Family Health Center
Cambridge, NY 12816-2618
Phone
(518) 677-3961
Fax
(518) 677-3180
NPI assigned
Nov 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2012

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 006413 NY Primary

Addresses

Primary practice location

35 Gilbert St
Cambridge Family Health Center
Cambridge, NY 12816-2618

Mailing address

PO Box 304
Glens Falls, NY 12801-0304
Phone (518) 677-3961

Other identifiers 2

IdentifierTypeStateIssuer
02347377MedicaidNY
P00031872OtherNYRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20100218000488 NY Practitioner - Physician Assistant 1153465836 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saratoga HospitalGroup PAC ID 6406740273, 353 clinicians

Practice addresses (Care Compare)

211 Church St
Saratoga Springs, NY 12866-1003
Phone (518) 583-8421

3040 Route 50
Saratoga Springs, NY 12866-3073
Phone (518) 580-2273

3044 Route 50
Saratoga Springs, NY 12866-3073
Phone (518) 886-5800

Hospital & facility affiliations

  • Saratoga Hospital Hospital, Saratoga Springs, NY, CCN 330222

Merit-based Incentive Payment System (MIPS)

Final score
68.51 of 100Reported as group
Quality
56.19
Improvement activities
40
Cost
75.36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
006413NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saratoga Hospital CurrentSince Aug 1, 2019 Accepting new patients
Saratoga Hospital CurrentSince Aug 1, 2019 Accepting new patients
Saratoga Regional Medical , P.C CurrentSince Aug 1, 2019 Accepting new patients
Saratoga Regional Medical , P.C Past Accepting new patients

Locations

2911 State Route 9
Ste 1
Malta, NY 12020
Phone (518) 363-8815

1275 Broadway
#106
Menands, NY 12204
Phone (518) 262-9705

1 West Ave
Ste 300
Saratoga Springs, NY 12866
Phone (518) 693-4699

3044 Route 50
Saratoga Springs, NY 12866
Phone (518) 886-5800

211 Church St
Saratoga Springs, NY 12866
Phone (518) 583-8461

Interoperability endpoints

  • Direct secure messaging: sstefanovich101927@albanymed.direct-ci.com

Organizations & group practices 6

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339372800000",
    "number": "1326039769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 304",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128010304",
            "telephone_number": "518-677-3961",
            "fax_number": "518-677-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 GILBERT ST",
            "address_2": "CAMBRIDGE FAMILY HEALTH CENTER",
            "city": "CAMBRIDGE",
            "state": "NY",
            "postal_code": "128162618",
            "telephone_number": "518-677-3961",
            "fax_number": "518-677-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEFANOVICH",
        "first_name": "STEFAN",
        "middle_name": "JOHN",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2012-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "006413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02347377",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00031872",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, NY

Sources for this page

Verify at the official NPI Registry.