Stephen D Hennessey, MD
Individual provider Active NPI General Practice Physician · Chehalis, WA
NPI 1376544098 · NPPES record last updated Oct 31, 2022
Key facts
- NPI
- 1376544098
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- MD00025264 (WA)
- Practice address
- 2690 NE Kresky Ave
Chehalis, WA 98532-2412 - Phone
- (360) 330-9595
- Fax
- (360) 330-9560
- NPI assigned
- Aug 3, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 15
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- General Practice
- Education
- University of Texas Medical School at Houston, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lewis County Community Health Services
Practice addresses (Care Compare)
117 Ramsey Way
Toledo, WA 98591-9900
Phone (360) 864-4400
1800 Cooks Hill Rd
Centralia, WA 98531-9162
Hospital & facility affiliations
- Providence Centralia Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061229000313 | WA | Practitioner - General Practice |
2668420902 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lewis County Community Health Services | Current |
Accepting new patients | |
| Lewis County Community Health Services | Current |
Accepting new patients | |
| Lewis County Community Health Services | Current | Accepting new patients | |
| Central Montana Medical Facilities, Inc. | Surgery | Past | Accepting new patients |
| Central Montana Medical Facilities, Inc | Past | Accepting new patients |
Locations
1800 Cooks Hill Rd
Ste F
Centralia, WA 98531
Phone (360) 330-8939
1800 Cooks Hill Rd
Ste G
Centralia, WA 98531
Phone (360) 736-3042
2690 NE Kresky Ave
Chehalis, WA 98532
Phone (360) 330-9595
300 Ocean Ave
Raymond, WA 98577
Phone (360) 942-2303
Interoperability endpoints
- stephen.hennessey.p1@direct.valleyviewhc.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | MD00025264 | WA | Yes |
Addresses
Primary practice location
2690 NE Kresky Ave
Chehalis, WA 98532-2412
Mailing address
2690 NE Kresky Ave
Chehalis, WA 98532-2412
Phone (360) 330-9595
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1008874 | Medicaid | WA |
Other providers in Chehalis, WA
- Tiffany Gabrielle Alexis Hayes
- Shannan D Headrick
- Jennifer Michelle Hedgers
- Paula Renee Heitkemper
- Heidi Mae Hendrickson
- Daniel Henricksen
- Daria Hernandez
- Ruyman David Hernandez
- Shawna Marie Herriford
- Sara Jeanne Hess
All providers in Chehalis, WA · General Practice Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.