Individual provider Active NPI

Barbara C Stubenhaus, CNS (RN, MS, CS)

  • Clinical Nurse Specialist
  • Andover, MA
National Provider Identifier
1710079033
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Nurse SpecialistTaxonomy code 364S00000X
License
RN96676 Issued in MA
Practice address
3 Dundee Park.
Suite B05
Andover, MA 01810
Phone
(987) 475-6622
Fax
(978) 475-8436
NPI assigned
Sep 28, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Clinical Nurse Specialist 364SP0808X 96676 MA
Clinical Nurse Specialist 364S00000X RN96676 MA Primary
Adult Psychiatric/Mental Health Clinical Nurse Specialist 364SP0809X RN96676 MA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN96676 MA
Nurse Practitioner 363L00000X RN96676 MA

Addresses

Primary practice location

3 Dundee Park.
Suite B05
Andover, MA 01810

Mailing address

3 Dundee Park,
Suite B05
Andover, MA 01810
Phone (987) 475-6622

Other identifiers 1

IdentifierTypeStateIssuer
1897985MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20050719000973 MA Practitioner - Certified Clinical Nurse Specialist (CNS) 7719914084 Practice locations: Andover, MA

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Boston University School of Medicine, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3 Dundee Park Dr
Suite B05
Andover, MA 01810-3723
Phone (978) 475-6622

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist, Master of Science

State licenses

LicenseStateTypeSpecialty
RN96676MAMDPsychiatric/Mental Health Nurse Practitioner
96676MAMDPsychiatric/Mental Health Clinical Nurse Specialist

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426809600000",
    "number": "1710079033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 DUNDEE PARK,",
            "address_2": "SUITE B05",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "01810",
            "telephone_number": "987-475-6622",
            "fax_number": "978-475-8436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 DUNDEE PARK.",
            "address_2": "SUITE B05",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "01810",
            "telephone_number": "987-475-6622",
            "fax_number": "978-475-8436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUBENHAUS",
        "first_name": "BARBARA",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "CNS (RN, MS, CS)",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2015-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0808X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": "MA",
            "license": "96676",
            "primary": false
        },
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "MA",
            "license": "RN96676",
            "primary": true
        },
        {
            "code": "364SP0809X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Adult",
            "state": "MA",
            "license": "RN96676",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN96676",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN96676",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1897985",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, MA

Sources for this page

Verify at the official NPI Registry.