Individual provider Active NPI

Stacy Ploom, MD

  • Diagnostic Radiology Physician
  • Cleveland, OH
National Provider Identifier
1750136966
Registry record updated Jun 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
57.261137 Issued in OH
Practice address
9500 Euclid Ave # JJ24
Cleveland, OH 44195-0002
Phone
(216) 444-2200
NPI assigned
Apr 22, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 57.261137 OH Primary
Internal Medicine Physician 207R00000X R80826 AZ

Addresses

Primary practice location

9500 Euclid Ave # JJ24
Cleveland, OH 44195-0002

Mailing address

9500 Euclid Ave # JJ24
Cleveland, OH 44195-0002

Other practice location 1

7901 E 22nd St
Tucson, AZ 85710-8509
Phone (520) 694-8888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20240708000733 AZ Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 3870037443

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R80826AZMDInternal Medicine Physician
57.261137OHMDDiagnostic Radiology Physician

NPI Registry JSON

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

{
    "created_epoch": "1713744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782691200000",
    "number": "1750136966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE # JJ24",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441950002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE # JJ24",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441950002",
            "telephone_number": "216-444-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7901 E 22nd St",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857108509",
            "country_code": "US",
            "telephone_number": "520-694-8888",
            "fax_number": "520-694-8466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PLOOM",
        "first_name": "STACY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-22",
        "last_updated": "2026-06-29",
        "certification_date": "2026-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "57.261137",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "R80826",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.