Individual provider Active NPI

Stephanie Rousseau, D.O.

  • Emergency Medicine Physician
  • Manchester, NH
National Provider Identifier
1578927133
Registry record updated Jun 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
19542 Issued in NH
Practice address
1 Elliot Way
Manchester, NH 03103
Phone
(603) 663-2830
NPI assigned
Apr 11, 2016
Last updated
Jun 18, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 19542 NH Primary

Addresses

Primary practice location

1 Elliot Way
Manchester, NH 03103

Mailing address

1 Elliot Way
Manchester, NH 03103-3502
Phone (603) 663-2830

Other practice location 1

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Other practice location 2

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Other names 1

  • Stephanie C. Shakr Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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
I20190806003457 NH Practitioner - Emergency Medicine 5799077939 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
West Virginia School of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Elliot Professional ServicesGroup PAC ID 6103727920, 429 clinicians

Practice addresses (Care Compare)

1 Elliot Way
Manchester, NH 03103-3502
Phone (603) 622-6484

185 Queen City Ave
Manchester, NH 03101-7121
Phone (603) 314-6900

25 Leavey Dr
Bedford, NH 03110-4437
Phone (603) 663-3740

40 Butrrick Rd
Londonderry, NH 03053-3381

One Elliot Way
100 Elliot Cardiovascular Consultants
Manchester, NH 03103-3502
Phone (603) 627-1669

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Elliot Professional Services Emergency Medicine CurrentSince Jul 1, 2019 Accepting new patients

Locations

25 Leavey Dr
Bedford, NH 03110
Phone (603) 472-5860

1 Elliot Way
Manchester, NH 03103
Phone (603) 663-2271

1 Elliot Way
Unit 1
Manchester, NH 03103

185 Queen City Ave
Manchester, NH 03101
Phone (603) 314-6900

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1578927133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ELLIOT WAY",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031033502",
            "telephone_number": "603-663-2830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ELLIOT WAY",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "03103",
            "telephone_number": "603-663-2830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "508-334-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "508-334-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROUSSEAU",
        "first_name": "STEPHANIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-11",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NH",
            "license": "19542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "SHAKR",
            "middle_name": "C.",
            "credential": "D.O.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Manchester, NH

Sources for this page

Verify at the official NPI Registry.