Individual provider Active NPI

Michael G Stebbins, M.D.

  • Diagnostic Radiology Physician
  • Princeton, NJ
National Provider Identifier
1619975489
Registry record updated Mar 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MA04686100 Issued in NJ
Practice address
41 Governors LN
Princeton, NJ 08540-3670
Phone
(609) 921-3579
NPI assigned
Jul 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MA04686100 NJ Primary

Addresses

Primary practice location

41 Governors LN
Princeton, NJ 08540-3670

Mailing address

41 Governors LN
Princeton, NJ 08540-3670
Phone (609) 921-3579

Other identifiers 1

IdentifierTypeStateIssuer
5039304MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20050718000140 NJ Practitioner - Diagnostic Radiology 3476457359 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of South Florida College of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercer Diagnostic Imaging, LLCGroup PAC ID 7113342825, 3 clinicians

Practice addresses (Care Compare)

1245 Whitehorse Mercerville Rd
Suite 403
Hamilton, NJ 08619-3831
Phone (609) 581-2727

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA04686100NJMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Burlington Diagnostic Imaging LLC Diagnostic Radiology CurrentSince Jan 23, 2021 Accepting new patients
Mercer Diagnostic Imaging, LLC Diagnostic Radiology CurrentSince May 27, 2020 Accepting new patients
Garden State Magnetic Imaging, P.C. Past Accepting new patients
Quakerbridge Radiology Associates PA Diagnostic Radiology Past Accepting new patients

Locations

2800 Route 130 N
Ste 202
Cinnaminson, NJ 08077
Phone (856) 210-7666

1245 Whitehorse Mercerville Rd
Ste 403
Trenton, NJ 08619
Phone (609) 581-2727

Organizations & group practices 4

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": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1267660800000",
    "number": "1619975489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 GOVERNORS LN",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085403670",
            "telephone_number": "609-921-3579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 GOVERNORS LN",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085403670",
            "telephone_number": "609-921-3579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEBBINS",
        "first_name": "MICHAEL",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2010-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "MA04686100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5039304",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Princeton, NJ

Sources for this page

Verify at the official NPI Registry.