Stephanie H Goede, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

085.004468 Issued in IL

Practice address

420 N Il Route 31
Crystal Lake, IL 60012

Phone

(815) 356-5200

Fax

(815) 356-5262

NPI assigned

Aug 30, 2012

Last updated

Jun 7, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ms. Stephanie H Stolen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Superior Health and Wellness of Crystal Lake, LTD.

  • Physical Medicine & Rehabilitation Physician
  • Crystal Lake, IL
  • NPI 1811266554
  NPD
• Centegra Primary Care, LLC

  dba Centegra Physician Care, LLC

  • Family Medicine Physician
  • Woodstock, IL
  • NPI 1700905205
  NPD (past)
• Dynamic Health & Wellness, LTD.

  • Physical Medicine & Rehabilitation Physician
  • Crystal Lake, IL
  • NPI 1942448451
  NPD (past)

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

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528329600000",
    "number": "1548519986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 N IL ROUTE 31",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600123709",
            "telephone_number": "815-356-5200",
            "fax_number": "815-356-5262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 N IL ROUTE 31",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60012",
            "telephone_number": "815-356-5200",
            "fax_number": "815-356-5262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10370 Haligus Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Huntley",
            "state": "IL",
            "postal_code": "601429582",
            "country_code": "US",
            "telephone_number": "815-356-5200",
            "fax_number": "815-356-5262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOEDE",
        "first_name": "STEPHANIE",
        "middle_name": "H",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-30",
        "last_updated": "2018-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085.004468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1108763",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "085004468",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "STOLEN",
            "middle_name": "H",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicole A Glinski, B.S, COTA/L
• Globa Medicare Inc
• Global Med Pro LLC
• Godfrey V. Viegas DPM, Foot and Ankle Center, Inc.
• Katherine Ann Godfrey, MD
• Grant Goehler, LCSW
• Megan Goff
• Juliana Gonzales-Hannon, CNP
• Elisabet Gonzalez, BT
• Gabriela Gonzalez

• Surgical Physician Assistant in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.