Individual provider Active NPI

Stefan Hannevig, PA-C

  • Medical Physician Assistant
  • Baltimore, MD
National Provider Identifier
1790039386
Registry record updated Nov 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
9000 Franklin Square Dr
Baltimore, MD 21237-3901
Phone
(443) 777-7000
NPI assigned
Nov 3, 2012
Last updated
Nov 3, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X NU Primary

Addresses

Primary practice location

9000 Franklin Square Dr
Baltimore, MD 21237-3901

Mailing address

644 Shrewsbury Commons Ave
Shrewsbury, PA 17361-1617
Phone (304) 893-2295

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130409000283 MD Practitioner - Physician Assistant 0143466557 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

410 Malcolm Dr
Suite a
Westminster, MD 21157-6160
Phone (410) 876-7772

5401 Old Court Rd
Randallstown, MD 21133-5103
Phone (410) 521-2200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.23 of 100Reported as group
Quality
60.26
Promoting interoperability
100
Improvement activities
40
Cost
76.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Hospital Center, Inc. CurrentSince Nov 6, 2017 Accepting new patients
Northwest Hospital Center, Inc CurrentSince Nov 6, 2017 Accepting new patients
Lifebridge Community Physicians Inc CurrentSince Jan 17, 2018 Accepting new patients
Lifebridge Community Physicians, Inc CurrentSince Jan 17, 2018 Accepting new patients

Locations

5401 Old Court Rd
Randallstown, MD 21133
Phone (301) 337-2727

410 Malcolm Dr
Ste A
Westminster, MD 21157
Phone (410) 876-1633

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1351900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351900800000",
    "number": "1790039386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 SHREWSBURY COMMONS AVE",
            "city": "SHREWSBURY",
            "state": "PA",
            "postal_code": "173611617",
            "telephone_number": "304-893-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 FRANKLIN SQUARE DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212373901",
            "telephone_number": "443-777-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNEVIG",
        "first_name": "STEFAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-03",
        "last_updated": "2012-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.