Robert Stuckert III, D.O.
Individual provider Active NPI Internal Medicine Physician · Beverly, OH
NPI 1396740445 · NPPES record last updated Aug 1, 2011
Key facts
- NPI
- 1396740445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 34006102S (OH)
- Practice address
- 531 5TH St
Beverly, OH 45715-8916 - Phone
- (740) 984-1414
- Fax
- (740) 984-1723
- NPI assigned
- Jun 16, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
531 5TH St
Beverly, OH 45715-0325
Phone (740) 984-1414
PO Box
Suite 325
Beverly, OH 45715-0325
Hospital & facility affiliations
- Housecalls Home Health
- Marietta Memorial Hospital
- Selby General Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- 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 |
|---|---|---|---|---|
| I20040428000979 | OH | Practitioner - Internal Medicine | 6608863972 | Practice locations: Beverly, OH; Marietta, OH |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34006102S | OH | MD | Internal Medicine Physician |
| 1553 | OH | MD | Foot & Ankle Surgery Podiatrist |
| 1553 | WV | MD | Physical Therapist |
| 6102 | OH | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Robert Stuckert III, D.O. | Internal Medicine | Past |
Accepting new patients |
| Bayfront Enterprises Inc | Past | Accepting new patients |
Interoperability endpoints
- robert.stuckert@mmhs.medicity.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 34006102S | OH | Yes |
Addresses
Primary practice location
531 5TH St
Beverly, OH 45715-8916
Mailing address
PO Box 325
Beverly, OH 45715-0325
Phone (740) 984-1414
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W06102 | Other | OH | HEALTH PLAN UPPER OH VALL |
| 201582447001 | Other | OH | BCBS MTN STATE |
| 000000346859 | Other | OH | BCBS ANTHEM |
| 0110570 | Medicaid | OH | |
| 7380139 | Other | OH | CIGNA |
| 4573606 | Other | OH | AETNA |
Other providers in Beverly, OH
- Emmeline Jane Miller
- Robert Stuckert III, D.O.
- Kayla Rorrer
- Betty J Schenkel
- Jordan Schilling
- Rebecca Wagner
- Shane R Wagner
- Ernest Paul Warren
- Waterford Township
- Jennifer Worthington
All providers in Beverly, OH · Internal Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2011. 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.