Individual provider Active NPI

Cassandra Stephens, MD

  • Family Medicine Physician
  • Campbellsville, KY
National Provider Identifier
1710983564
Registry record updated Aug 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
31329 Issued in KY
Practice address
70 Ubermonkey LN
Campbellsville, KY 42718-5217
Phone
(270) 465-0060
Fax
(270) 465-0134
NPI assigned
Jun 27, 2005
Reactivated
Mar 30, 2006
Last updated
Aug 3, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 3, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 31329 KY Primary

Addresses

Primary practice location

70 Ubermonkey LN
Campbellsville, KY 42718-5217

Mailing address

70 Ubermonkey LN
Campbellsville, KY 42718-5217
Phone (270) 465-0060

Other identifiers 1

IdentifierTypeStateIssuer
64032014MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20040105000009 KY Practitioner - Family Practice 1557260031

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
92.9 of 100Reported as group
Quality
85.93
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Enterprises, Inc. Family Medicine Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438560000000",
    "number": "1710983564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 UBERMONKEY LN",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427185217",
            "telephone_number": "270-465-0060",
            "fax_number": "270-465-0134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 UBERMONKEY LN",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427185217",
            "telephone_number": "270-465-0060",
            "fax_number": "270-465-0134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "CASSANDRA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-27",
        "last_updated": "2015-08-03",
        "deactivation_date": "2006-03-17",
        "reactivation_date": "2006-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "31329",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64032014",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Campbellsville, KY

Sources for this page

Verify at the official NPI Registry.