Individual provider Active NPI

Tianna Stephens

  • Medical Physician Assistant
  • Rockville Centre, NY
National Provider Identifier
1497364111
Registry record updated Jul 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
165 N Village Ave Ste 5
Rockville Centre, NY 11570-3701
Phone
(516) 766-0393
NPI assigned
Jul 28, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AM0700X NY Primary

Addresses

Primary practice location

165 N Village Ave Ste 5
Rockville Centre, NY 11570-3701

Mailing address

2 Central Ave
Glen Cove, NY 11542-2905

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210127000906 NY Practitioner - Physician Assistant 2860806213 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Telehealth LLCGroup PAC ID 6608156906, 43 clinicians
Ally Medical PCGroup PAC ID 2769857218, 9 clinicians

Practice addresses (Care Compare)

150 Sunnyside Blvd
Plainview, NY 11803-1504
Phone (888) 982-8594

200 Broadhollow Rd
Suite 207
Melville, NY 11747-4806
Phone (888) 982-8594

30 Hempstead Ave
Suite 144
Rockville Centre, NY 11570-4034
Phone (516) 764-6464

Hospital & facility affiliations

  • Tender Loving Care, an Amedisys Company Home health agency, Carle Place, NY, CCN 337143

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595894400000",
    "number": "1497364111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 CENTRAL AVE",
            "city": "GLEN COVE",
            "state": "NY",
            "postal_code": "115422905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 N VILLAGE AVE STE 5",
            "city": "ROCKVILLE CENTRE",
            "state": "NY",
            "postal_code": "115703701",
            "telephone_number": "516-766-0393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "TIANNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-28",
        "last_updated": "2020-07-28",
        "certification_date": "2020-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville Centre, NY

Sources for this page

Verify at the official NPI Registry.