Stacey Stokes Roussell, MD
Individual provider Active NPI Pediatrics Physician · Louisville, KY
NPI 1770629099 · NPPES record last updated May 8, 2024
Key facts
- NPI
- 1770629099
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 35005 (KY)
- Practice address
- 439 Country LN
Louisville, KY 40207-1803 - Phone
- (502) 939-5378
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120224000720 | KY | Practitioner - Pediatric Medicine | 1153589965 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Norton Children'S Medical Group, LLC | Current |
Accepting new patients | |
| Norton Children'S Medical Group, LLC | Current | Accepting new patients | |
| Norton Children'S Medical Group, LLC | Current |
Accepting new patients | |
| Community Medical Associates, Inc. | Current |
Accepting new patients | |
| Community Medical Associates, Inc. | Current | Accepting new patients | |
| Community Medical Associates, Inc. | Pediatrics | Current |
Accepting new patients |
| Grace Pediatrics PLLC | Pediatrics | Past |
Accepting new patients |
| Grace Pediatrics PLLC | Pediatrics | Past | Accepting new patients |
| Brentwood Pediatrics PLLC | Pediatrics | Past | Accepting new patients |
Locations
601 S Floyd St
Ste 604
Louisville, KY 40202
Phone (502) 559-1670
4010 DuPont Cir
Ste 283
Louisville, KY 40207
Phone (502) 897-1727
825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165
Interoperability endpoints
- sroussell5474@direct.nortonhealthcare.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | 35005 | KY | |
| Pediatrics Physician | 208000000X | 35005 | KY | Yes |
Addresses
Primary practice location
439 Country LN
Louisville, KY 40207-1803
Mailing address
439 Country LN
Louisville, KY 40207-1803
Phone (502) 939-5378
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000200556 | Other | KY | ANTHEM |
| 64035678 | Medicaid | KY | |
| 000000200556 | Other | KY | PASSPORT HEALTH PLAN |
| 50035679 | Other | KY | PASSPORT - KCMA |
| 000000739400 | Other | KY | ANTHEM - KCMA |
| 129357 | Other | KY | SIHO - KCMA |
| 611356201 | Other | KY | TAX ID |
Other providers in Louisville, KY
- Robin Rouse
- Stephanie Rouse
- Richard Schuyler Roush
- Morgan Ansley Rousseau
- Sydney H Rousseau
- Amit Rout
- Joann Rowan
- Angela C Rowe
- Grace Rowe
- Jennifer L Rowe
All providers in Louisville, KY · Pediatrics Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.