Individual provider Active NPI

Roy Justin Stacer, DO

  • Internal Medicine Physician
  • Orlando, FL
National Provider Identifier
1508448788
Registry record updated Jul 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
OS20429 Issued in FL
Practice address
21 Columbia St Ste 201
Orlando, FL 32806-1133
Phone
(321) 841-6600
Fax
(321) 841-4085
NPI assigned
Apr 27, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X FL
Internal Medicine Physician 207R00000X OS20429 FL Primary

Addresses

Primary practice location

21 Columbia St Ste 201
Orlando, FL 32806-1133

Mailing address

21 Columbia St Ste 201
Orlando, FL 32806-1133
Phone (321) 841-6600

Other practice location 1

52 W Underwood St
Orlando, FL 32806-1110
Phone (321) 841-5145

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20240718001761 FL Practitioner - Internal Medicine 9638571649 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Orlando Physicians Network IncGroup PAC ID 7719026251, 231 clinicians

Practice addresses (Care Compare)

21 Columbia St
Orlando, FL 32806-1133
Phone (321) 841-6600

Hospital & facility affiliations

  • Orlando Health Hospital, Orlando, FL, CCN 100006
  • Orlando Health-Health Central Hospital Hospital, Ocoee, FL, CCN 100030

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS20429FLMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Physicians Network Inc Internal Medicine CurrentSince Aug 1, 2024 Accepting new patients

Locations

21 Columbia St
Ste 201
Orlando, FL 32806
Phone (321) 841-0746

52 Underwood St
Orlando, FL 32806
Phone (321) 841-3581

21 Columbia St
Orlando, FL 32806
Phone (321) 841-5560

Organizations & group practices 1

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 3

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": "1619481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1508448788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 COLUMBIA ST STE 201",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061133",
            "telephone_number": "321-841-6600",
            "fax_number": "321-841-4085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 COLUMBIA ST STE 201",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328061133",
            "telephone_number": "321-841-6600",
            "fax_number": "321-841-4085"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "52 W Underwood St",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328061110",
            "country_code": "US",
            "telephone_number": "321-841-5145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STACER",
        "first_name": "ROY",
        "middle_name": "JUSTIN",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-27",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS20429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.