Individual provider Active NPI

Stacie B Peddy, M.D.

  • Pediatric Critical Care Medicine Physician
  • Miami, FL
National Provider Identifier
1700805090
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
ME167338 Issued in FL
Practice address
3100 SW 62ND Ave
Miami, FL 33155-3009
Phone
(305) 666-6511
NPI assigned
Jul 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X MD426570 PA
Pediatrics Physician 208000000X MD426570 PA
Pediatric Critical Care Medicine Physician 2080P0203X MD426570 PA
Pediatric Critical Care Medicine Physician 2080P0203X D92544 MD
Pediatric Critical Care Medicine Physician 2080P0203X ME167338 FL Primary

Addresses

Primary practice location

3100 SW 62ND Ave
Miami, FL 33155-3009

Mailing address

3100 SW 62ND Ave
Miami, FL 33155-3009
Phone (305) 666-6511

Other identifiers 4

IdentifierTypeStateIssuer
101470283MedicaidPA
242289EMDOtherPAMEDICARE PTAN
0092967MedicaidNJ
659065900MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20060213000226 PA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Pediatric MedicinePractitioner - Critical Care (Intensivists) 5294740650 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME167338FLMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Anesthesiology Associates, LTD Pediatrics CurrentSince May 30, 2012 Accepting new patients
Children's Anesthesiology Associates, LTD Pediatrics CurrentSince May 30, 2012 Accepting new patients
University of Maryland Pediatric Associates, PA Pediatrics CurrentSince Jul 9, 2022 Accepting new patients
Children's Anesthesiology Associates, LTD Current Accepting new patients
University of Maryland Pediatric Associates, PA Pediatrics CurrentSince Jul 9, 2022 Accepting new patients

Locations

22 S Greene St
Baltimore, MD 21201
Phone (410) 328-5793

12500 Willowbrook Rd
Cumberland, MD 21502
Phone (240) 964-1255

324 S 34th St
Ste 9329
Philadelphia, PA 19104
Phone (215) 590-1867

100 E Penn Sq
Bldg 9TH
Philadelphia, PA 19107
Phone (267) 425-9538

3401 Civic Center Blvd
Ste 9329
Philadelphia, PA 19104
Phone (267) 425-9300

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

Interoperability endpoints

  • Direct secure messaging: speddy847890@direct.umm.edu

Organizations & group practices 5

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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1700805090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SW 62ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331553009",
            "telephone_number": "305-666-6511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SW 62ND AVE",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331553009",
            "telephone_number": "305-666-6511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDDY",
        "first_name": "STACIE",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-18",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "PA",
            "license": "MD426570",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD426570",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "PA",
            "license": "MD426570",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MD",
            "license": "D92544",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "FL",
            "license": "ME167338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101470283",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "242289EMD",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0092967",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "659065900",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.