Kimberly Sue Stuckey Schrock, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01060332A Issued in IN

Practice address

2016 S Main St
Goshen, IN 46526-5236

Phone

(574) 533-7600

Fax

(574) 533-7666

NPI assigned

Aug 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Family Practice

Education

Wright State University Boonshoft School of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medicine Reimagined DPCGroup PAC ID 0143639666, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Goshen Hospital Hospital, Goshen, IN, CCN 150026

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.stuckey-schrock.1@24150.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/24150/brand/1/csg/1/fhir/r4

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.

• Medicine Reimagined DPC

  • Family Medicine Physician
  • Goshen, IN
  • NPI 1891375275
  Medicare reassignment Care Compare group NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Goshen Hospital Association Inc

  • General Acute Care Hospital
  • Goshen, IN
  • NPI 1740268846
  Care Compare affiliation

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620000000000",
    "number": "1457467995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2016 S MAIN ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465265236",
            "telephone_number": "574-533-7600",
            "fax_number": "574-533-7666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2016 S MAIN ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465265236",
            "telephone_number": "574-533-7600",
            "fax_number": "574-533-7666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUCKEY SCHROCK",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2021-05-03",
        "certification_date": "2021-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01060332A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200526460",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kimberly.stuckeyschrockmd.p1@direct.goshenphysicians.nextgenshare.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2016 S Main St",
            "city": "Goshen",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465265236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Glenn B Stoltzfus, M.D.
• Ruth Stoltzfus, CPNP
• Kiley Stone, PA-C
• Pamela Joybirkholz Stone, M.D.
• Lindsey N Stose, MSW, LSW
• Teneesa Stuckey, WHNP
• Stacia Stults
• Chad G. Stutsman, DDS
• Gene A. Stutsman, DDS
• Phyllis D Stutzman, MSW

• Family Medicine Physician in Goshen, IN
• Providers in Goshen, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.