Individual provider Active NPI

Alyssa R Stout, DDS

  • Dentist
  • New Church, VA
National Provider Identifier
1619404514
Registry record updated Nov 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
0401416060 Issued in VA
Practice address
5219 Lankford Hwy
New Church, VA 23415-3332
Phone
(757) 824-5676
NPI assigned
May 22, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X VA
Dentist 122300000X 0401416060 VA Primary

Addresses

Primary practice location

5219 Lankford Hwy
New Church, VA 23415-3332

Mailing address

5219 Lankford Hwy
New Church, VA 23415-3332
Phone (757) 824-5676

Other practice location 1

386 Ben Bolt Ave
Tazewell, VA 24651
Phone (276) 979-9899

Other names 1

  • Alyssa R Franklin Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170906002880 VA Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 1254604622
I20180911001647 VA Order and Referring Only - DentistPractitioner - Dentist 1254604622

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
DRS Schroeder Stenger & Cole Dentist Current Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1495411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1619404514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5219 LANKFORD HWY",
            "city": "NEW CHURCH",
            "state": "VA",
            "postal_code": "234153332",
            "telephone_number": "757-824-5676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5219 LANKFORD HWY",
            "city": "NEW CHURCH",
            "state": "VA",
            "postal_code": "234153332",
            "telephone_number": "757-824-5676"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "386 Ben Bolt Ave",
            "address_purpose": "LOCATION",
            "city": "Tazewell",
            "state": "VA",
            "postal_code": "24651",
            "country_code": "US",
            "telephone_number": "276-979-9899",
            "fax_number": "276-979-9798",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOUT",
        "first_name": "ALYSSA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-22",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401416060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALYSSA",
            "last_name": "FRANKLIN",
            "middle_name": "R",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New Church, VA

Sources for this page

Verify at the official NPI Registry.