Individual provider Active NPI

Stacy L Scudder

  • Pediatrics Physician
  • Canal Winchester, OH
National Provider Identifier
1598707515
Registry record updated Jan 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
34.007025 Issued in OH
Practice address
6201 Gender Rd
Canal Winchester, OH 43110-2007
Phone
(614) 834-8042
Fax
(614) 837-8035
NPI assigned
Jun 12, 2006
Last updated
Jan 19, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 34.007025 OH Primary

Addresses

Primary practice location

6201 Gender Rd
Canal Winchester, OH 43110-2007

Mailing address

6201 Gender Rd
Canal Winchester, OH 43110-2007
Phone (614) 834-8042

Other identifiers 1

IdentifierTypeStateIssuer
2191748MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20051002000005 OH Practitioner - Pediatric Medicine 6800821539 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Ohio University, College of Osteopathic Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6201 Gender Rd
Canal Winchester, OH 43110-2007
Phone (614) 834-8042

Merit-based Incentive Payment System (MIPS)

Final score
87.04 of 100Reported as group
Quality
85.5
Improvement activities
40
Cost
83.38

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34.007025OHMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Ohio Primary Care Physicians, Inc. Pediatrics CurrentSince Apr 27, 2010 Accepting new patients
Central Ohio Primary Care Physicians Inc Current Accepting new patients
Central Ohio Primary Care Physicians, Inc. CurrentSince Apr 27, 2010 Accepting new patients

Locations

6201 Gender Rd
Canal Winchester, OH 43110
Phone (614) 585-9900

4885 Olentangy River Rd
Columbus, OH 43214
Phone (614) 326-5665

655 Africa Rd
Westerville, OH 43082

Interoperability endpoints

  • Direct secure messaging: sscudder19126@copcp.medicity.net

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263859200000",
    "number": "1598707515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 GENDER RD",
            "city": "CANAL WINCHESTER",
            "state": "OH",
            "postal_code": "431102007",
            "telephone_number": "614-834-8042",
            "fax_number": "614-837-8035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6201 GENDER RD",
            "city": "CANAL WINCHESTER",
            "state": "OH",
            "postal_code": "431102007",
            "telephone_number": "614-834-8042",
            "fax_number": "614-837-8035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCUDDER",
        "first_name": "STACY",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2010-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "34.007025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2191748",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canal Winchester, OH

Sources for this page

Verify at the official NPI Registry.