Individual provider Active NPI

Stephanie Marie Chismar, D.O.

  • Anesthesiology Physician
  • Charleston, SC
National Provider Identifier
1750794582
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
36686 Issued in SC
Practice address
169 Ashley Ave
Room 202 Main Hospital
Charleston, SC 29425-8905
Phone
(843) 792-2437
NPI assigned
Jun 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 36686 SC Primary

Addresses

Primary practice location

169 Ashley Ave
Room 202 Main Hospital
Charleston, SC 29425-8905

Mailing address

169 Ashley Ave
Room 202 Main Hospital
Charleston, SC 29425-8905
Phone (843) 792-2437

Other names 1

  • Stephanie Marie Henning Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20180613000516 NC Practitioner - Anesthesiology 7618266750 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Lake Erie College of Osteopathic Medicine, Erie, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Anesthesiology Associates PAGroup PAC ID 3971566761, 218 clinicians

Practice addresses (Care Compare)

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 384-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36686SCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Anesthesiology Associates, P.a. Anesthesiology CurrentSince Jul 2, 2018 Accepting new patients

Locations

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

131 Providence Rd
Ste 200
Charlotte, NC 28207
Phone 70474958001101

1918 Randolph Rd
Ste 740
Charlotte, NC 28207
Phone (704) 316-0810

Organizations & group practices 1

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1402358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402358400000",
    "number": "1750794582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE",
            "address_2": "ROOM 202 MAIN HOSPITAL",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258905",
            "telephone_number": "843-792-2437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 ASHLEY AVE",
            "address_2": "ROOM 202 MAIN HOSPITAL",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258905",
            "telephone_number": "843-792-2437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHISMAR",
        "first_name": "STEPHANIE",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-10",
        "last_updated": "2014-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "SC",
            "license": "36686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "HENNING",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.