Individual provider Active NPI

Kevin F Staveley-Ocarroll, M.D.

  • Surgery Physician
  • Farmington, CT
National Provider Identifier
1679539803
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
076526 Issued in CT
Practice address
263 Farmington Avenue
Farmington, CT 06030-8063
Phone
(860) 679-8080
Fax
(860) 679-1340
NPI assigned
Apr 25, 2006
Last updated
Mar 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 076526 CT Primary
Surgery Physician 208600000X MD071461L PA
Surgery Physician 208600000X 2015030565 MO
Surgical Oncology Physician 2086X0206X 35558 SC
Surgical Oncology Physician 2086X0206X 2015030565 MO

Addresses

Primary practice location

263 Farmington Avenue
Farmington, CT 06030-8063

Mailing address

263 Farmington Avenue
Farmington, CT 06030-8063
Phone (860) 679-8080

Other practice location 1

1 Hospital Dr
Columbia, MO 65212-0001
Phone (573) 884-4854

Other identifiers 1

IdentifierTypeStateIssuer
0018125830001MedicaidPA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address MUDOCREFERRAL@direct.health.missouri.edu Direct Curators of the University of Missouri
Direct Messaging Address kstaveleyocarroll74125@direct.med.uchc.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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
I20240305000245 CT Practitioner - General Surgery 2668669201 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Oklahoma College of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

263 Farmington Ave
Farmington, CT 06030-0001
Phone (860) 679-3692

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair - groin (open)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
076526CTMDSurgery Physician
2015030565MOMDSurgical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Connecticut Health Center CurrentSince Feb 1, 2024 Accepting new patients
University of Connecticut Health Center Surgical Oncology CurrentSince Feb 1, 2024 Accepting new patients
University of Connecticut Health Center Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

263 Farmington Ave
Farmington, CT 06030
Phone (860) 679-4477

65 Kane St
West Hartfrd, CT 06119
Phone (860) 523-6421

Interoperability endpoints

  • Direct secure messaging: kstaveleyocarroll74125@direct.med.uchc.edu

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

Hospital & facility affiliations 2

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": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1679539803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVENUE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060308063",
            "telephone_number": "860-679-8080",
            "fax_number": "860-679-1340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVENUE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060308063",
            "telephone_number": "860-679-8080",
            "fax_number": "860-679-1340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "652120001",
            "country_code": "US",
            "telephone_number": "573-884-4854",
            "fax_number": "573-884-6054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAVELEY-OCARROLL",
        "first_name": "KEVIN",
        "middle_name": "F",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CT",
            "license": "076526",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD071461L",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2015030565",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "SC",
            "license": "35558",
            "primary": false
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "MO",
            "license": "2015030565",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018125830001",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "MUDOCREFERRAL@direct.health.missouri.edu",
            "affiliation": "Y",
            "endpointDescription": "Endpoint is used to receive electronic continuity of care documents (C-CDA) for outpatient referrals.",
            "affiliationName": "Curators of the University of Missouri",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct",
            "address_1": "1 Hospital Dr",
            "city": "Columbia",
            "state": "MO",
            "country_code": "US",
            "postal_code": "652015276",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kstaveleyocarroll74125@direct.med.uchc.edu",
            "affiliation": "N",
            "address_1": "263 Farmington Avenue",
            "city": "Farmington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060308063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.