Active NPI
Stacy Ann Marie Davis, MD
- Rheumatology Physician
- Melbourne, FL
National Provider Identifier
1457551657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- ME105521
- Practice address
- 1334 Valentine St
Melbourne, FL 32901-3128 - Phone
- (321) 676-1870
- Fax
- (321) 768-2172
- NPI assigned
- Jul 25, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | ME105521 | FL | Primary |
Addresses
Primary practice location
1334 Valentine St
Melbourne, FL 32901-3128
Mailing address
95 Bulldog Blvd
Suite 202
Melbourne, FL 32901-3332
Phone (321) 727-2990
Other identifiers 19
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1082606 | Other | FL | CAREPLUS |
| 149KA | Other | FL | BCBS |
| 59-3169815 | Other | FL | BEECHSTREET |
| 59-3169815 | Other | FL | COVENTRY/CCN/FIRST HEALTH |
| 59-3169815 | Other | FL | NPPN/COALITION AMERICA |
| 59-3169815 | Other | FL | TRICARE |
| PRO11849 | Other | FL | QUALITY HEALTH PLAN |
| 3666528 | Other | FL | CIGNA |
| 3666528 | Other | FL | GREATWEST |
| 59-3169815 | Other | FL | IHG/HEALTHSMART |
| 6573631 | Other | FL | AETNA HMO |
| 581795 | Other | FL | WELLCARE |
| 59-3169815 | Other | FL | MULTIPLAN |
| 59-3169815 | Other | FL | EVOLUTIONS |
| 59-3169815 | Other | FL | UNITED HEALTHCARE |
| 9787626 | Other | FL | AETNA PPO |
| 0000000 | Other | FL | FLORIDA DOCTORS INS/MALPRACTICE CARRIER |
| 59-3169815 | Other | FL | HUMANA CHOICE |
| 003136400 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1330992000000",
"number": "1457551657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "95 BULLDOG BLVD",
"address_2": "SUITE 202",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329013332",
"telephone_number": "321-727-2990",
"fax_number": "321-724-0455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1334 VALENTINE ST",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329013128",
"telephone_number": "321-676-1870",
"fax_number": "321-768-2172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "STACY",
"middle_name": "ANN MARIE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-25",
"last_updated": "2012-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "FL",
"license": "ME105521",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREPLUS",
"identifier": "1082606",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "149KA",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEECHSTREET",
"identifier": "59-3169815",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY/CCN/FIRST HEALTH",
"identifier": "59-3169815",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPPN/COALITION AMERICA",
"identifier": "59-3169815",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "59-3169815",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUALITY HEALTH PLAN",
"identifier": "PRO11849",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "3666528",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREATWEST",
"identifier": "3666528",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHG/HEALTHSMART",
"identifier": "59-3169815",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "6573631",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "581795",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MULTIPLAN",
"identifier": "59-3169815",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVOLUTIONS",
"identifier": "59-3169815",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "59-3169815",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PPO",
"identifier": "9787626",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA DOCTORS INS/MALPRACTICE CARRIER",
"identifier": "0000000",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA CHOICE",
"identifier": "59-3169815",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003136400",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.