Stacey S Tull, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2000153517 Issued in MO

Practice address

1493 Cottleville Pkwy
Cottleville, MO 63376-3564

Phone

(636) 317-3376

Fax

(636) 244-1197

NPI assigned

May 23, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

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

DermatologyAlso: Micrographic Dermatologic Surgery (MDS)

Education

Duke University School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Epiphany Dermatology of Missouri LLC 21 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

88.84 of 100Reported as group

Quality

80.25

Promoting interoperability

100

Improvement activities

40

Cost

82.55

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stacey.tull@epiphanyderm.emadirect.md

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.

• Epiphany Dermatology of Missouri, LLC

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1528573342

  Dermatology, MO

  Medicare reassignment Care Compare group NPD
• Dermatology Associates, Inc.

  • Dermatology Physician
  • Saint Louis, MO
  • NPI 1205933546

  Dermatology

  NPD (past)
• SSM Health Care St. Louis

  • Emergency Medicine Physician
  • Saint Charles, MO
  • NPI 1427002922
  NPD (past)
• SSM Health Care St. Louis

  • Emergency Medical Services (Emergency Medicine) Physician
  • Lake St Louis, MO
  • NPI 1538113097
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1467407239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1493 COTTLEVILLE PKWY",
            "city": "COTTLEVILLE",
            "state": "MO",
            "postal_code": "633763564",
            "telephone_number": "636-317-3376",
            "fax_number": "362-441-1976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1493 COTTLEVILLE PKWY",
            "city": "COTTLEVILLE",
            "state": "MO",
            "postal_code": "633763564",
            "telephone_number": "636-317-3376",
            "fax_number": "636-244-1197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TULL",
        "first_name": "STACEY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2000153517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "susan@sccdermsurgery.com",
            "affiliation": "N",
            "address_1": "1493 Cottleville Pkwy",
            "city": "Cottleville",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633763564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Susan K. Sneed-Horace, R.N.;B.S.N.
• Jennifer Southward, CPNP
• St Charles County Dermatologic Surgery, LLC
• Scott Thornhill
• Tross Elite Golf Performance and Wellness LLC
• Wendo Home Health Agency LLC
• Caitlyn Elise Wiehe
• Mark Alan Wilkins, O.D.
• Maclane Wilson
• Kaitlyn Renee Witte, BCBA LBA

• All providers in Cottleville, MO
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.