Active NPI
Stacey A Robertson, DO
- Family Medicine Physician
- Bolivar, PA
National Provider Identifier
1346201274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- O5004404L
- Practice address
- 802 McKinley St
Bolivar Medical Center
Bolivar, PA 15923 - Phone
- (724) 676-4709
- Fax
- (724) 676-4752
- NPI assigned
- Mar 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | O5004404L | PA | Primary |
Addresses
Primary practice location
802 McKinley St
Bolivar Medical Center
Bolivar, PA 15923
Mailing address
PO Box 38
Bolivar, PA 15923-0038
Phone (724) 676-4709
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101206165 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O5004404L | PA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Health Network | Past | Accepting new patients | |
| Windber Hospital, Inc. | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Emlenton, PA
- NPI 1750181038
-
- General Acute Care Hospital
- Windber, PA
- NPI 1275620536
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314230400000",
"number": "1346201274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 38",
"city": "BOLIVAR",
"state": "PA",
"postal_code": "159230038",
"telephone_number": "724-676-4709",
"fax_number": "724-676-4752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "802 MCKINLEY ST",
"address_2": "BOLIVAR MEDICAL CENTER",
"city": "BOLIVAR",
"state": "PA",
"postal_code": "15923",
"telephone_number": "724-676-4709",
"fax_number": "724-676-4752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "STACEY",
"middle_name": "A",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-30",
"last_updated": "2011-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "O5004404L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101206165",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bolivar, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.