James Russell Keller Stackhouse, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME117902 Issued in FL

Practice address

6 S 14TH St
Fernandina, FL 32034

Phone

(904) 261-5741

Fax

(904) 261-7383

NPI assigned

Jun 4, 2009

Last updated

Sep 29, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA, FL2 enrollments

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 2

Specialty

Ophthalmology

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Russell Stackhouse MD PAGroup PAC ID 9133473325, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ed Fraser Memorial Hospital Hospital, Macclenny, FL, CCN 100134

Merit-based Incentive Payment System (MIPS)

Final score

92.84 of 100Reported as group

Quality

85.67

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Russell Stackhouse MD PA

  dba Coastal Vision Center

  • Ophthalmology Physician
  • Fernandina, FL
  • NPI 1538655014

  GA

  Medicare reassignment Care Compare group NPD
• Amelia Island Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Fernandina Beach, FL
  • NPI 1972194199
  NPD
• Florida Retina Institute James a Staman MD LLC

  dba Florida Retina Institute

  • Ophthalmology Physician
  • Orlando, FL
  • NPI 1447328026
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baker County Medical Services Inc

  • Rural Acute Care Hospital
  • Macclenny, FL
  • NPI 1104926401
  Care Compare affiliation

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

{
    "created_epoch": "1244073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632873600000",
    "number": "1750517710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 S 14TH ST",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320343212",
            "telephone_number": "904-261-5741",
            "fax_number": "904-261-7383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 S 14TH ST",
            "city": "FERNANDINA",
            "state": "FL",
            "postal_code": "32034",
            "telephone_number": "904-261-5741",
            "fax_number": "904-261-7383"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31 S 6th St",
            "address_purpose": "LOCATION",
            "city": "Macclenny",
            "state": "FL",
            "postal_code": "320632311",
            "country_code": "US",
            "telephone_number": "904-261-5741",
            "fax_number": "904-261-7383",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "542069 US Highway 1",
            "address_purpose": "LOCATION",
            "city": "Callahan",
            "state": "FL",
            "postal_code": "320118110",
            "country_code": "US",
            "telephone_number": "904-261-5741",
            "fax_number": "904-261-7383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STACKHOUSE",
        "first_name": "JAMES",
        "middle_name": "RUSSELL KELLER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-04",
        "last_updated": "2021-09-29",
        "certification_date": "2021-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "GA",
            "license": "770778",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME117902",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100661200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Elliot Packer, M.D.
• Professional Dental Alliance of Fernandina Beach, PLLC
• Tia Briana Raysor, PHARMD
• Russell Stackhouse MD PA (Coastal Vision Center)
• Robert Harvey Springer III, P.T.A.
• Taylor John Vissers

• Ophthalmology Physician in Fernandina, FL
• Providers in Fernandina, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.