NPIMap

Individual provider Active NPI

Stephanie A Parker, D.O.

  • Family Medicine Physician
  • Pueblo, CO
National Provider Identifier
1538135561
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
50145 Issued in CO
Practice address
300 Colorado Ave
Pueblo, CO 81004-2006
Phone
(719) 543-8711
Fax
(719) 543-5340
NPI assigned
Feb 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 50145 CO Primary

Addresses

Primary practice location

300 Colorado Ave
Pueblo, CO 81004-2006

Mailing address

110 E Routt Ave
Pueblo, CO 81004-2117
Phone (719) 543-8711

Other identifiers 1

IdentifierTypeStateIssuer
26000750MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120709000225 CO Practitioner - Family Practice 4082664149 Reassigns benefits to 1 organization
I20231010000159 TX Practitioner - Family Practice 4082664149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Oklahoma State University College of Osteopathic Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1921 Stonecipher Dr
Ada, OK 74820-3439
Phone (580) 436-3980

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Chickasaw Nation Division of Health Chickasaw Nation Medical Center CurrentSince Oct 5, 2023 Accepting new patients
Chickasaw Nation Division of Health CurrentSince Oct 5, 2023 Accepting new patients
Pueblo Community Health Center Inc CurrentSince May 1, 2012 Accepting new patients
Chickasaw Nation Division of Health Current Accepting new patients
Pueblo Community Health Center Inc CurrentSince May 1, 2012 Accepting new patients

Locations

300 Colorado Ave
Pueblo, CO 81004
Phone (719) 543-8718

110 E Routt Ave
Pueblo, CO 81004
Phone (719) 543-8718

1921 Stonecipher Dr
Ada, OK 74820
Phone (580) 421-4570

2510 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-8181

1438 Hardcastle Blvd
Purcell, OK 73080
Phone (405) 527-4700

817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392

Interoperability endpoints

  • Direct secure messaging: sparker23647@direct.chickasawnationhealth.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375747200000",
    "number": "1538135561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E ROUTT AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042117",
            "telephone_number": "719-543-8711",
            "fax_number": "719-543-5340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 COLORADO AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042006",
            "telephone_number": "719-543-8711",
            "fax_number": "719-543-5340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "STEPHANIE",
        "middle_name": "A",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2013-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "50145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "26000750",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.