Stacey Ann Walker, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

239852 Issued in NY

Practice address

112 Kimball Ave
Penn Yan, NY 14527-1816

Phone

(315) 536-2752

Fax

(315) 536-4005

NPI assigned

Jul 27, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Finger Lakes Community Health

  • Federally Qualified Health Center (FQHC)
  • Port Byron, NY
  • NPI 1114198819
  Medicare reassignment NPD
• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Staten Island, NY
  • NPI 1750469912
  Medicare reassignment NPD
• Finger Lakes Community Health

  • Federally Qualified Health Center (FQHC)
  • Dundee, NY
  • NPI 1366939878
  NPD
• Finger Lakes Migrant Health Care Project, Inc

  • Federally Qualified Health Center (FQHC)
  • Geneva, NY
  • NPI 1225366966
  NPD
• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Corinth, NY
  • NPI 1003957424
  NPD
• The Frederick Ferris Thompson Hospital

  • General Acute Care Hospital
  • Canandaigua, NY
  • NPI 1194776351
  NPD
• Chemung Medical Services PC

  • Internal Medicine Physician
  • Elmira, NY
  • NPI 1356378889
  NPD (past)
• Fort Edward Rescue Squad Inc

  • Ambulance
  • Fort Edward, NY
  • NPI 1427031319
  NPD (past)
• The Frederick Ferris Thompson Hospital

  • Community/Retail Pharmacy
  • Victor, NY
  • NPI 1831914274
  NPD (past)

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487203200000",
    "number": "1386668655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MAIDEN LN",
            "address_2": "PO BOX 423",
            "city": "PENN YAN",
            "state": "NY",
            "postal_code": "145271208",
            "telephone_number": "315-531-9102",
            "fax_number": "315-531-9103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 KIMBALL AVE",
            "city": "PENN YAN",
            "state": "NY",
            "postal_code": "145271816",
            "telephone_number": "315-536-2752",
            "fax_number": "315-536-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "STACEY",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-27",
        "last_updated": "2017-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "239852",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "239852",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "239852",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02799228",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erica J Verdehem, RN
• Douglas Calvin Wager, RPH
• Walgreen Co
• Lisa Lynn Walk-Reinard, M.D.
• Karen Long Walker
• Alissa Blake Walruth, LMHC-D
• Water Street Pharmacy Inc.
• Water Street Pharmacy, Inc.
• Barbara J Weld, BACHELORS DEGREE
• Kathryn Ann Wiley, OT

• Internal Medicine Physician in Penn Yan, NY
• Providers in Penn Yan, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.