Individual provider Active NPI

Courtney Brooke Stevens, PA-C

  • Physician Assistant
  • Tifton, GA
National Provider Identifier
1639423189
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
006659 Issued in GA
Practice address
1007 Greenfield Dr
Tifton, GA 31794-3795
Phone
(229) 382-9733
Fax
(229) 387-6161
NPI assigned
Nov 6, 2012
Last updated
Dec 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 006659 GA Primary

Addresses

Primary practice location

1007 Greenfield Dr
Tifton, GA 31794-3795

Mailing address

1007 Greenfield Dr
Tifton, GA 31794-3795
Phone (229) 382-9733

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address courtney.stevens@trhs.cernerdirect.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130109000033 GA Practitioner - Physician Assistant 8224281928 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical College of Georgia School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tift Regional Health System IncGroup PAC ID 2062745169, 294 clinicians

Practice addresses (Care Compare)

1007 Greenfield Dr
Tifton, GA 31794-3795
Phone (229) 382-9733

2225 US Hwy 41 N
Tifton, GA 31794-2749
Phone (229) 391-4100

2227 US Hwy 41 N
Tifton, GA 31794-2749
Phone (229) 353-6188

901 18TH St E
Tifton, GA 31794-3648
Phone (229) 382-7120

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tift Regional Health System Inc CurrentSince Mar 1, 2020 Accepting new patients
Tift Regional Health System Inc CurrentSince Mar 1, 2020 Accepting new patients
Tift Regional Health System Inc CurrentSince Nov 2, 2015 Accepting new patients
Coffee Regional Medical Center, Inc CurrentSince Nov 19, 2012 Accepting new patients
Coffee Regional Medical Center, Inc CurrentSince Nov 19, 2012 Accepting new patients
Tift Regional Health System Inc CurrentSince Nov 2, 2015 Accepting new patients

Locations

260 Mj Taylor Rd
Adel, GA 31620
Phone (229) 247-2290

1101 Ocilla Rd
Douglas, GA 31533
Phone (912) 383-5641

205 Shirley Ave
Douglas, GA 31533
Phone (912) 260-5400

1007 Greenfield Dr
Tifton, GA 31794
Phone (229) 382-9733

2225 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-3422

2227 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-6188

901 18th St E
Tifton, GA 31794
Phone (229) 353-6208

Interoperability endpoints

  • Direct secure messaging: courtney.stevens@trhs.cernerdirect.com

Organizations & group practices 8

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": "1352160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1639423189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 GREENFIELD DR",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943795",
            "telephone_number": "229-382-9733",
            "fax_number": "229-387-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 GREENFIELD DR",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943795",
            "telephone_number": "229-382-9733",
            "fax_number": "229-387-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEVENS",
        "first_name": "COURTNEY",
        "middle_name": "BROOKE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-06",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "006659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "courtney.stevens@trhs.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1007 Greenfield Dr",
            "city": "Tifton",
            "state": "GA",
            "country_code": "US",
            "postal_code": "317943795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.