NPIMap

Individual provider Active NPI

Stephen N Dallas, M.D., M.A.

  • Internal Medicine Physician
  • Kalamazoo, MI
National Provider Identifier
1356393482
Registry record updated Feb 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301067063 Issued in MI
Practice address
3601 S 9TH St
Kalamazoo, MI 49009-9538
Phone
(269) 383-6789
Fax
(269) 383-6767
NPI assigned
May 17, 2006
Last updated
Feb 9, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301067063 MI Primary

Addresses

Primary practice location

3601 S 9TH St
Kalamazoo, MI 49009-9538

Mailing address

3601 S 9TH St
Kalamazoo, MI 49009-9538
Phone (269) 383-6789

Other identifiers 1

IdentifierTypeStateIssuer
4236764MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20050912000991 MI Practitioner - Internal Medicine 1557273968

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Tennessee, HSC, College of Medicine, 1995
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

3601 S 9TH St
Kalamazoo, MI 49009-9538

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Opus Medicine, PC CurrentSince Feb 1, 2012 Accepting new patients
Bronson South Haven Hospital Internal Medicine Past Accepting new patients
Bronson South Haven Hospital Past Accepting new patients
Paragon Health PC PastSince Mar 6, 2000 Accepting new patients
Southwestern Medical Clinic PC Past Accepting new patients
Evergreen Manor Senior Care Centre, LLC Past Accepting new patients

Locations

3601 S 9th St
Kalamazoo, MI 49009
Phone (269) 372-4700

3601 S 9th St
Rm 6
Kalamazoo, MI 49009
Phone (269) 488-3061

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16402/brand/1/csg/1/fhir/r4
  • Direct secure messaging: stephen.dallas.1@16402.direct.athenahealth.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518134400000",
    "number": "1356393482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 S 9TH ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490099538",
            "telephone_number": "269-383-6789",
            "fax_number": "269-383-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 S 9TH ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490099538",
            "telephone_number": "269-383-6789",
            "fax_number": "269-383-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALLAS",
        "first_name": "STEPHEN",
        "middle_name": "N",
        "credential": "M.D., M.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2018-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301067063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4236764",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.