Peter Douglas Stephan, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01035748A Issued in IN

Practice address

188 E Southway Blvd
Kokomo, IN 46902-3650

Phone

(765) 453-9000

NPI assigned

Jun 24, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Family Practice

Education

Northwestern University Feinberg Medical School, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Vincent Medical Group IncGroup PAC ID 7012047640, 728 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension St Vincent Kokomo Hospital, Kokomo, IN, CCN 150010

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• St. Vincent Medical Group, Inc.

  dba Ascension Medical Group St. Vincent

  • Orthopaedic Surgery Physician
  • Winchester, IN
  • NPI 1144513375
  Medicare reassignment Care Compare group
• Riggs Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Lafayette, IN
  • NPI 1386660900
  NPD (past)
• Riggs Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Lafayette, IN
  • NPI 1386876233
  NPD (past)
• St Vincent Medical Group Inc

  • Cardiovascular Disease Physician
  • Indianapolis, IN
  • NPI 1558686436
  NPD (past)
• Wagoner Medical Center, LLC

  • Family Medicine Physician
  • Burlington, IN
  • NPI 1457421497
  NPD (past)
• Chatuge Regional Hospital Inc

  dba Chatuge Medical Group

  • Internal Medicine Physician
  • Hiawassee, GA
  • NPI 1265811962
  NPD (past)
• Chatuge Regional Hospital Inc

  • Critical Access Hospital
  • Hiawassee, GA
  • NPI 1326028978
  NPD (past)
• Taylor Regional Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Hawkinsville, GA
  • NPI 1225057425
  NPD (past)
• Wendy L Smith M.D. PC

  • Otolaryngology Physician
  • Blairsville, GA
  • NPI 1184880338
  NPD (past)

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

• St. Joseph Hospital & Health Center, Inc.

  dba Ascension St. Vincent Kokomo

  • General Acute Care Hospital
  • Kokomo, IN
  • NPI 1780625442
  Care Compare affiliation

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

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659484800000",
    "number": "1548266307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "188 E SOUTHWAY BLVD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 E SOUTHWAY BLVD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023650",
            "telephone_number": "765-453-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "712 W Main St",
            "address_purpose": "LOCATION",
            "city": "Greentown",
            "state": "IN",
            "postal_code": "469361045",
            "country_code": "US",
            "telephone_number": "765-628-3317",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEPHAN",
        "first_name": "PETER",
        "middle_name": "DOUGLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-24",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "053956",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "55024",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01035748A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01551745",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "624637757A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "peter.stephan.1@7598.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "St. Vincent Medical Group, Inc.",
            "address_1": "188 E Southway Blvd",
            "city": "Kokomo",
            "state": "IN",
            "country_code": "US",
            "postal_code": "469023650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• John Gilbert Stark Jr., MA, LMHC
• Karen Marie Starkey, CNA
• Jennifer Michelle Starr, MA, CCC-SLP
• Step N Stone Home Health Care LLC
• Step N Stone LLC
• Hunter Stephens, RBT
• Jordan Stephens, RBT
• Travis Christopher Stephens, O.D.
• Steven a Hott Obstetrics and Gynecology
• Steven J Seele DC PC (Seele Chiropractic Center)

• Family Medicine Physician in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.