Individual provider Active NPI

Stephanie Humbert

  • Primary Care Nurse Practitioner
  • Waterloo, NY
National Provider Identifier
1356022560
Registry record updated Jul 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
F351974-01 Issued in NY
Practice address
367 E Main St
Waterloo, NY 13165-1662
Phone
(315) 521-9228
NPI assigned
Jul 31, 2023
Last updated
Jul 31, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X F351974-01 NY Primary

Addresses

Primary practice location

367 E Main St
Waterloo, NY 13165-1662

Mailing address

3605 Lakes Corners Rose Valley Rd
Clyde, NY 14433-9606
Phone (315) 521-9228

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: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231228002475 NY Practitioner - Nurse Practitioner 7315397684 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Geneva General Hospital, IncGroup PAC ID 7810809407, 88 clinicians

Practice addresses (Care Compare)

4 W Genesee St
Clyde, NY 14433-1126
Phone (315) 923-3640

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F351974-01NYMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Soldiers & Sailors Memorial Hospital Current Accepting new patients
Geneva General Hospital, Inc. CurrentSince Nov 8, 2023 Accepting new patients
Geneva General Hospital, Inc CurrentSince Nov 8, 2023 Accepting new patients
Soldiers & Sailors Memorial Hospital Past Accepting new patients
Geneva General Hospital Inc. Past Accepting new patients

Locations

4 W Genesee St
Clyde, NY 14433
Phone (315) 923-3640

196 North St
Geneva, NY 14456
Phone (315) 787-4000

1991 Balsley Rd
Seneca Falls, NY 13148
Phone (315) 539-0237

367 E Main St
Waterloo, NY 13165
Phone (315) 539-0580

367 E Main St
Ste A
Waterloo, NY 13165
Phone (315) 787-4977

Interoperability endpoints

  • Direct secure messaging: s.humbert@flhmedical.medentdirect.com

Organizations & group practices 5

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": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1356022560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 LAKES CORNERS ROSE VALLEY RD",
            "city": "CLYDE",
            "state": "NY",
            "postal_code": "144339606",
            "telephone_number": "315-521-9228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 E MAIN ST",
            "city": "WATERLOO",
            "state": "NY",
            "postal_code": "131651662",
            "telephone_number": "315-521-9228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMBERT",
        "first_name": "STEPHANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-31",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NY",
            "license": "F351974-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, NY

Sources for this page

Verify at the official NPI Registry.